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Exam 3 - Nursing 140

Terms in this set (77)

5 types of adolescent disorders:
1) Attention Deficit Hyperactivity Disorder (ADHD)

2) Tourette's

3) Oppositional Defiant Disorder (ODD)

4) Conduct Disorder

5) Separation Anxiety Disorder
Attention Deficit Hyperactivity Disorder (ADHD):
---> child often displays a persistent pattern of inattention and/or hyperactivity & impulsivity.

- difficult to diagnose ADHD before the age of 4; around the age of 4, children start to enter into an organized school setting (pre-school, or pre-k class), so once a child is in school, the symptoms of ADHA are more recognizable.

- is more common in boys.

- may occur in 10.2% of school age children.

- if ADHD persists into adulthood, 25% of individuals from the 10.2% will go on to meet criteria for antisocial personality disorder.

- we see a higher incidence of ADHD in chaotic & dysfunctional family systems.

- 20% of individuals diagnosed with ADHD will also have a diagnosis of anxiety disorders, 30% will experience depression, 20% will experience bipolar disorder, & up to 50% will experience oppositional defiant disorder.

- substance abuse is typically a problem in ADHD patients; stimulants (Cocaine) is highly addictive in these patients.

*** early detection & treatment of ADHD =
- improves social skills & peer relationships.
- improves academic achievements.


---> 3 Subtypes of ADHD:

1) Combined Type:
- the majority of kids with ADHD fall into this subtype.
- to be diagnosed, kids must meet at least 6 symptoms of the predominantly inattentive type, & 6 symptoms of the predominantly hyperactive/impulsivity type, with these symptoms crossing the line of social occupational functioning for greater than 6 months.

2) Predominantly Inattentive Type:
- to be diagnosed, you have to have 6 or more symptoms of inattention that are crossing the line of social occupational functioning (school) for greater than 6 months.
-> inattention symptoms include......
- not paying close attention to details; making
careless mistakes.
- difficulty remaining focused on a conversation
or lesson plan.
- often fail to finish their chores or school work.
- have difficulty organizing their tasks or
belongings; they are very disorganized.
- reluctant to engage in any activity that requires
sustained mental effort (ex: hw assignments).
- often loose the things they need in order to
complete their task (ex: school supplies).
- very easily distracted.
- often very forgetful (about hw or daily tasks).

3) Predominantly Hyperactive/Impulsive Type:
- to be diagnosed, you have to have 6 or more symptoms of hyperactivity/impulsivity that are crossing the line of social occupational functioning (school) for greater than 6 months.
-> hyperactivity/impulsivity symptoms include..........
- difficulty staying seated/still when expected to.
- making unnecessary noise/over interacting
with others.
- consistently on the go.
- driven by motor, they talk excessively.
- they often interrupt in a conversation.
- they can't wait their turn or stay in place in line.
ADHD Symptomatology:
- easily distracted.
- short attention spans.
- unable to complete tasks.
- impulsive.
- poor interpersonal relationships.
- low self esteem.
- disruptive & intrusive.
- non-compliance with social norms.
- aggressive.
- oppositional.
- regressed/immature behavior.
- low frustration tolerance.
- temper tantrums.
- boundless energy (accident prone, may lead to multiple emergency room visits).
- excessive activity.
- accident prone.
Ex. question...

A patient comes in with a diagnosis of bipolar disorder, substance abuse, and ADHD. What is the first thing we need to work on?
---> we need to first stabilize the disease of addiction; you can't diagnose a patient who is under the influence of substances & you can't begin a treatment.

- then, we need to stabilize the bipolar disorder, which complicates ADHD treatment; it is contraindicated to give an addict with mania a CNS stimulant (even though the stimulant treats ADHD), so we would look for a non-stimulant option.
Tourette's:
---> the presence of multiple motor tics, & 1 or more verbal tics.

- to be diagnosed, the tics must interfere with social & occupational functioning.

- the onset is typically as early as age 2, but is most common between ages 6-7.

- more common in boys.

- the symptoms may be lifelong, or they may diminish after adolescence.

- symptoms may exacerbate during periods of stress & may diminish when the individual is focused on an activity.

-> comorbid disorders...
- high link with Tourette's causing depression & anxiety.
- up to 50% of individuals diagnosed with Tourette's also have ADHD.
- up to 40% of individuals diagnosed with Tourette's also have OCD.
Tourette's Symptomatology:
Vocal Tics:
- clicks, grunts, barks, coughs, sniffs, & snorts.
- obscenities in 10% of cases (ex: shouting "ketchup, mustard, hotdog, relish!").
-> Palilalia = repeating one's own sounds (ex: pt. says "What's for dinner? dinner").
-> Echolalia = repeating what others say (ex: someone says "wanna go to the store" & pt. says "to store, store, store").

Motor Tics:
-> Simple Tics....
- eye blinking.
- neck jerking.
- shrugging.
- grimacing.
- coughing.
-> Complex Tics....
- tapping.
- squatting.
- hopping.
- skipping.
- retracing steps.
- twirling.
Oppositional Defiant Disorder:
---> persistent pattern of angry mood & defiant behavior.

- prevalence in 2-16% of the population.

- interferes with social, educational, & occupational function; arguing for the sake of arguing.

- onset is typically by 8 years of age.

- comorbid disorders include anxiety, mood disorders, & ADHD.

- predisposing factors are family dynamics (ex. a strong willed child has a strong authoritative parent who says it's my way or no way....leads to a recipe for disaster); child will initially defy the parents before defying anything/anyone else.

- more common in boys before puberty; then it becomes an equal chance between boys & girls after puberty.

- some individuals may eventually develop conduct disorder as well.
Oppositional Defiant Disorder Symptomatology:
- argumentative; arguing just for the sake of arguing.
- passive-aggressive behaviors.
- running away.
- school avoidance.
- limit testing.
- don't take ownership for their mistakes; lots of defensive coping mechanisms.
- resistance to directions.
- negativism.
- deliberately ignoring the communication of others.
- unwillingness to compromise.
- enuresis (voluntarily wetting the bed; very extreme).
- under achievements academically.
- temper tantrums.
- fighting.
- spiteful, vindictive behavior.
Conduct Disorder:
---> repetitive & persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms/rules are violated.

- 40% of boys & 25% of girls with conduct disorder will develop antisocial personality disorder.

- comorbid disorders include ADHD, mood disorders, learning disorders, & substance use disorders.

- more common in boys.

- up to 10% of the population could meet the criteria for conduct disorder.

- physical aggression in common & peer relationships are disturbed.

-> predisposing factors include..........
- parental rejection or peer rejection.
- tremendous economic stressors within the family.
- inconsistent management with harsh discipline (the child makes the same mistake multiple times, but the parents give really radical punishments that vary each time).
- early institutional living (foster care, etc).
- frequent shifting of a parental figure.
- frequent shifting of residences.
- parents with antisocial personality disorder or
substance abuse within the home.
- marital conflict or divorce w/ poor communication.
- parental permissiveness (parents give no
discipline, but also no praise).


*** the different between conduct disorder & oppositional defiant disorder is that conduct disorder is violating the rights of others.


---> 2 Subtypes:

1) Childhood Onset Conduct Disorder:
- more severe.
- when the symptoms of violating the rights of others are present before the age of 10.
- these are the individuals who often go on to develop antisocial personality disorder.

2) Adolescent Onset Conduct Disorder:
- less severe.
- these individuals tend to become passive-aggressive adults w/ communication problems.
Conduct Disorder Symptomatology:
- physical aggression.
- violates the rights of others at an early age.
- stealing, lying, truancy.
- lacks guilt/remorse.
- early use of alcohol/tobacco.
- early sexual activity.
- projection defense mechanism (projects their problems onto others).
- low self-esteem; "tough guy" image.
- low frustration tolerance.
- temper outbursts.
- depression/anxiety are common.
- low academic achievement.
Separation Anxiety Disorder:
---> excessive fear or anxiety concerning separation from those to whom the individual is attached.

- typically occurs before 18 years old; most commonly occurs between ages 5-6.

- more common in girls.

- population prevalence is 4%.

- comorbidities include phobias & depressed mood.

- most children will outgrow this disorder, however this disorder can be a precursor to adult panic disorder.

-> predisposing factors include....
- children with anxiety disorders often have parents
with anxiety disorders.
- natural temperament; "inhibition to the unfamiliar"
(it's not good, it's not bad, it just is).
- stressful life events.
- parents can instill anxiety into children by being
over protective or over-exaggerating a danger.
Separation Anxiety Disorder Symptomatology:
- difficulty separating from the mother.
- the anticipation of separation may result in crying, tantrums, screaming, complaints of physical problems, & clinging behaviors.
- reluctance or refusal to attend school.
- refusal to sleep away from home.
- worrying (not natural for a childhood).
- nightmares.
Between all 5 adolescent disorders, what problems can these children/adolescents have?
- anxiety.
- physical injuries (specifically to ADHD).
- poor relationships to others.
- feel bad about themselves.
- can be violent (specific to conduct disorder).
- can't cope with life.
Between all 5 adolescent disorders, what are the goals for these kinds of patients?
- no physical harm to self or others (specific to ADHD & conduct).

- appropriate interactions w/ others (specific to ADHD, conduct, oppositional defiant disorder).

- positive self concept.

- fewer demanding behaviors (specific to ADHD, oppositional defiant).

- follows rules w/o becoming defensive (specific to oppositional defiant & conduct disorder).

- cooperation & completion of tasks (specific to ADHD, oppositional defiant).

- demonstrates self-control by managing tics (specific to Tourette's).

- able to accept direction w/o becoming defensive (specific to oppositional defiant, conduct disorder).

- decreased anxiety upon separation from caregiver (specific to separation anxiety disorder).
Between all 5 adolescent disorders, collaborative interventions include....
- Family Therapy.
- Group Therapy.
- Behavioral Therapy.
- Cognitive Therapy.
- Parent Training Programs.

---> we do not offer medications to young children for oppositional defiant disorder, conduct disorder, or separation anxiety disorder.

Psychopharmacology options for treating ADHD or Tourette's includes....
- CNS stimulants.
- Strattera.
- Wellbutrin.
- Alpha Agonist.
- Haldol & Atypical Anti-psychotics (Tourette's).
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