Chapter 29Infant, Child, and
Adolescent Clients
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Unity
I dreamed I stood in a studio and watched two
sculptors there. The clay they used was a young
child’s mind and they fashioned it with care. One was
a teacher; the tools she used were books and music
and art. One a parent with a guiding hand and gentle
loving heart. Day after day the teacher toiled with
touch that was deft and sure, while the parent labored
by the side and polished and smoothed it o’er. And
when at last their task was done, they were proud of
what they had wrought. For the things they had
molded into the child could neither be sold nor bought.
And each agreed they would have failed if they had
worked alone, for behind the parent stood the school
and behind the teacher, the home.
Author Unknown
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Learning Objectives
After studying this chapter, you should be able to
•
Explain the limitations involving the study of the
genetics of behavioral disorders in children
•
Articulate the relationship between the psychosocial
process of attachment and child development
•
Identify the seven groups of children considered to be
at higher risk for mental health disorders
•
Differentiate four types of intellectual disability (also
referred to as mental retardation)
•
Distinguish attention deficit hyperactivity disorder from
conduct disorder
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Learning Objectives (cont.)
• Articulate the etiology and clinical symptoms of
attention deficit hyperactivity disorder in adults
• Distinguish autistic disorder from Asperger’s
disorder and Rett’s disorder
• Compare and contrast clinical symptoms of
oppositional defiant disorder and conduct disorder
• Develop an assessment tool for childhood and
adolescent depression
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Learning Objectives (cont.)
• Formulate a list of at least three nursing interventions for each
of the following clients.
– A 15-year-old girl with conduct disorder
– A 12-year-old boy with clinical symptoms of depression
– A 7-year-old boy with attention deficit hyperactivity
disorder
– A 4-year-old girl with autistic behavior
– A 3-year-old girl with separation anxiety disorder
– A 9-year-old boy with childhood psychosis
• Formulate a list of pharmacologic agents approved for use in the
treatment of children and adolescents
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Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Crisis in Children’s Mental Health
Services Is Influenced by the Following
• No single cause of mental health and psychiatric
disorders
• Shortage of child and adolescent psychiatrists
• Scarcity of trained clinicians such as psychiatric–mental
health clinical nurse specialists, advanced nurse
practitioners, clinical child psychologists, and social
workers
• Inadequate screening and referral
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Etiology—Mental Retardation
• Genetic
• Developmental
• Acquired syndromes
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Etiology—Pervasive Developmental
Disorders (Autism Spectrum Disorders)
These disorders are characterized by severe deficits
and impairment in reciprocal social interaction and
communication. These include stereotyped behaviors,
interests, and activities.
• Rett’s disorder
• Autistic disorder
• Asperger’s disorder
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Etiology—Attention Deficit Hyperactivity
Disorder (ADHD)
Etiological hypotheses:
• Neuromaturational delay
• Catecholamine deficits
• Altered glucose metabolism in the brain
• Frontal lobe dysfunction
• Central nervous system infections
• Perinatal insults
• Brain injuries during or after birth
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Etiology—Childhood Psychosis
• Genetic factors
• Early-onset schizophrenia or other disorder
• Neuropathology
• Intrauterine stress
• Neuropsychological abnormalities
• Communication style
• Life events
• Stress
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Etiology—Anxiety
• Disorders include the following:
– Separation anxiety disorder
– Social phobia
– School phobia
– Panic disorder
– Generalized anxiety disorder (GAD)
• Precipitating factors:
– Stressful life events, loss of a parent, etc.
– Etiology not well known; not enough data
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Etiology—Mood Disorders
• Genetic predisposition
• Environmental influences
• Risk factors include the following:
– Learning disabilities
– History of abuse or neglect
– History of trauma
– Loss of significant other
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Etiology—Disruptive Behavior Disorder:
Conduct Disorders
• Parental and family factors
• Sociocultural factors
• Psychological factors
• School-related factors
• Neurobiological theories
• Medical and metabolic theories
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Risk Factors for the Development of
Psychiatric–Mental Health Disorders
Psychosocial
• Children in families with
conflict or divorce
• Children of substanceabusing and mentally ill
parents
• Children who experience
poverty
• Children of teenage
parents
• Children of minority ethnic
status
• Children with chronic
illness or disability
• Children who are abused
Environmental
• Public schools
• Neighborhoods
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Clinical Symptoms and Diagnostic
Characteristics
• Mental retardation
• Pervasive developmental disorders
– Autistic disorder
– Asperger’s disorder
• Attention deficit hyperactivity disorder and disruptive
behavior disorder
– ADHD
– Disruptive behavior disorders
• Oppositional defiant disorder (ODD)
• Conduct disorders
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Clinical Symptoms and Diagnostic
Characteristics (cont.)
• Tic disorders
– Tourette’s syndrome
• Elimination disorders
– Enuresis
– Encopresis
• Other disorders
– Separation anxiety disorder
– Mood disorders
– Adjustment disorders
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The Nursing Process
• Assessment
• Nursing diagnoses
• Outcome identification
• Planning interventions
• Implementation
• Evaluation
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Assessment
• Assessment of a child
– With autistic disorder
– With ADHD
• Assessment of an adolescent
• Transcultural considerations
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Nursing Diagnoses
ADHD
Conduct Disorder
• Disturbed sleep pattern
• Risk for other-directed
violence
• Interrupted family
processes
• Risk for injury
• Impaired social interaction
• Hopelessness
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Nursing Diagnoses (cont.)
Autistic Disorder
• Disturbed sensory
perception
• Self-mutilation
Separation Anxiety
Disorder
• Disturbed sleep pattern
• Anxiety
• Impaired social interaction
with peers and parents
• Impaired verbal
communication
• Self-care deficit
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Outcome Identification
Outcomes generally focus on the following:
• Reduction of clinical symptoms
• Decreased stress
• Progression of normal developmental stages
• Therapeutic changes
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Planning Interventions
Nursing interventions are planned to
• Help the child or adolescent master developmental tasks
to overcome regressive, slow, or impaired developmental
behavior
• Establish a method of communication with clients who
have difficulty communicating, such as the withdrawn,
disoriented, mute, hostile, preoccupied, or autistic child
or adolescent
• Identify stimuli that might foster abusive, destructive, or
otherwise negative behavior
• Allow time for the client to respond to therapeutic
interventions
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Implementation
• Interventions for mental retardation
– Assistance in meeting basic needs
– Client and family education
• Interventions for ADHD
– Assistance in meeting basic needs
– Client and family education
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Implementation (cont.)
• Interventions for ODD and conduct disorder
– Assistance in meeting basic needs
– Client and family education
• Interventions for autistic disorder
– Assistance in meeting basic needs
– Behavior management
– Client and family education
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Implementation (cont.)
• Interventions for mood disorders
– Assistance in meeting basic needs
– Client and family education
• Interventions for anxiety
– Assistance in meeting basic needs
– Client and family education
– Special needs of adolescents
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Implementation (cont.)
Continuum of Care
• Inpatient
hospitalization
• Day-treatment
hospitals
• Alternative families
• Individual
psychotherapy
• Group therapy
• Play therapy
• Behavioral therapy
• Art and music therapy
• Community- and
school-based
interventions
• Family therapy
(systems therapy)
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Evaluation
Positive responses to treatment will be evidenced in the
following:
• Changes in mood or behavior since the initial
assessment
• The efficacy of prescribed medication
• Improved family dynamics
• Socialization and progress in school
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Key Terms
• Asperger’s disorder
• Mental retardation
• Attachment theory
• ODD
• ADHD
• Rett’s disorder
• Autistic disorder
• Scapegoat
• Conduct disorder
• Developmental disability
• Encopresis
• Tic
• Tourette’s syndrome
• Enuresis
• Intellectual disability
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Reflection
Reflect on the chapter-opening quote.
• What does the author imply in the final
statement “For behind the parent stood the
school and behind the teacher, the home?”
?
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins