Objective 1
Identifying etiology and characteristics of specified childhood/adolescent psychiatric illnesses

Disorders Affecting Children/Adolescents
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Intellectual Developmental Disorder
Autism Spectrum Disorder
Attention-Deficit/Hyperactivity Disorder
Oppositional Defiant Disorder
Conduct Disorder
Tourette’s Disorder
Separation Anxiety Disorder

Intellectual Developmental Disorder
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Involves deficits in general intellectual functioning and adaptive functioning
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General intellectual functioning = measured by an individual’s performance on IQ tests
Adaptive functioning = refers to the person’s ability to adapt to the requirements of daily living and the expectations of age and cultural group
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IQ is 70 or below
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Deficits/impairment in communication, selfcare, self-direction, leisure, and safety

Intellectual Developmental Disorder (cont’d)
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Predisposing factors:
– Hereditary
 Approximately 5% of cases
 Down’s syndrome, Tay-Sachs disease
– Early alterations in embryonic development
 Drug/alcohol toxicity
 Maternal illnesses/infections
– Pregnancy and prenatal problems
 Birth injuries
– General medical conditions acquired in infancy or early childhood
– Environmental influences and other mental disorders

Autism Spectrum Disorder
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Characterized by a withdrawal into the self and into a fantasy world of one’s own creation
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Development in social interaction and communication is markedly abnormal or impaired
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Activities and interests are restricted; may be considered bizarre
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Prevalence of approximately 1 in 150 children in the U.S.
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Onset occurs before age 3

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Attention-Deficit/Hyperactivity Disorder
(ADHD)
Persistent pattern of inattention and/or hyperactivity-impulsitivity that is more frequent and severe than is typically observed in individuals at same developmental level
Hyperactivity = excessive psychomotor activity that may be purposeful or aimless, accompanied by physical movements that are usually more rapid than normal
Impulsitivity = acting without reflection and without thought to the consequences

ADHD (cont’d)
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Onset of disorder difficult to diagnose in children younger than age 4
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ADHD often not recognized until child enters school
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Five to nine times more common in boys than in girls
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Believed to have strong genetic component
– Parent with ADHD may have child with ADHD
– Sibling string
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Possible link to high serum lead levels

Oppositional Defiant Disorder (ODD)
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Characterized by a pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures that occurs more frequently than is usually observed in individuals of same age/developmental level
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Typically begins by age 8, and usually not later than early adolescence
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May precede a conduct disorder
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“Normal” oppositional phases occur in older infancy, toddlerhood, and adolescence

Conduct Disorder
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Repetitive and persistent pattern of behavior in which basic rights of others or major age-appropriate societal norms or rules are violated
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Physical aggression common
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Childhood-onset = begins prior to age 10; more likely to have continued problems during adolescence, and antisocial as adult
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Adolescent-onset = absence of any criteria characteristic of conduct disorder before age 10

Tourette’s Disorder
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Presence of multiple motor tics along with one or more vocal tics
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Tics may appear simultaneously or at different periods during the illness
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Causes marked distress or interferes with various areas of functioning
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Onset occurs before the age of 18
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Characterized by periods of remission
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Symptoms usually diminish during adolescence and adulthood

Separation Anxiety Disorder
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Involves excessive anxiety concerning separation from the home or from those to whom the person is attached
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Considered in excess of what would be expected for developmental level
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Interferes with social, academic, and occupational levels of functioning
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More common in girls than in boys
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Etiological factors may include stressful life events and/or family influences

Objective 2
Examining medical treatments and nursing interventions for clients experiencing a childhood/adolescent psychiatric disorder

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Behavior Therapy
– Classical conditioning, operant conditioning
– Useful for disruptive behavior disorders
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Family Therapy
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Family Education
– Behavior modification techniques
– Consistency
Group Therapy
– Opportunity to interact with peers
– Learning of appropriate social behaviors
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Psychopharmacology

Objective 3
Exploring concerns associated with providing psychiatric care to children and adolescents

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Medication issues
– Dosing problems
– Addiction
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Legal issues
– Guardianship concerns
– Safety
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Developmental issues
– Appropriateness of behaviors compared to norms of life stage
Parental/caregiver issues
– Manipulation of health care system
– Knowledge deficits

Objective 4
Applying the nursing process to the treatment of special populations

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Assessment
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Nursing Diagnosis
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Planning
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Implementation
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Evaluation