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Learning objectives: At the end of the

Developmental discussion, learners will be able to:
Disorders of  Identify the characteristics, risk factors and family dynamics of
Childhood psychiatric disorders of childhood and adolescence.
 Apply nursing process to the care of children and adolescents with
psychiatric disorders and their families.
 Provide education to clients, family, teachers, caregivers and
Prepared by: community members for young clients with psychiatric disorders.

Gemma V. Panal, RN,MN, LPT

 Discuss the nurse’s role advocate for children & adolescents.

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Overview General characteristics of clients

with these disorders:
A. definitions
1. infancy – birth to 12 months A. impaired growth and development
2. childhood – beginning with toddlerhood through patterns
preschool, elementary, and middle school period. B. physical illness
C. failure to establish relationships with peers
3. adolescence – starts at the age of 12-13 through
D. overachievement or underachievement
teenage years, even up to 21 years.
E. over involvement or under involvement with
age-related activities

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General characteristics of clients

with these disorders:
Developmental disorders
f. Family systems problems
g. Expression of self-disgust, sadness
h. Impaired age appropriate reality base
i. Poor impulse control
j. Sexual acting-out
k. Aggressive and destructive behavior

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1. Mental Retardation DEGREE OF RETARDATION

 below average intellectual a. mild retardation: IQ 50 to 70
functioning of 70.
 impaired social & b. moderate retardation: IQ 35 to 50
communication skills, and c. severe retardation: IQ 20 to 35
inability to be self – sufficient.
d. profound retardation: IQ less than 20
 onset before the age of 18

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Causes of MR 2. Learning Disorders

a. Hereditary  dx: when the child’s achievement in reading,
mathematics, or written expression is below than
b. Maternal alcohol intake expected.
c. Perinatal problems  Low self-esteem and poor social skills are common
d. Medical conditions  Tx: includes assisting in academic achievement.
e. Environmental influences

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3. Motor Skills Disorder 4. Communication Disorders

 developmental coordination disorder
 impaired coordination severe enough to interfere with academic  occurs when a
achievement communication deficit is
 dx is not made if the problem is part of a medical general condition. severe enough to hinder
 treatment includes therapy such as Adaptive physical education and development, academic
specific therapies. achievement, or activities of
daily living including
socialization.

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Types of Communication disorders:
1. expressive language disorder
2. mixed receptive expressive language
disorder
3. phonologic disorder
4. stuttering
tx : speech therapy
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 this category of disorders also called
autism spectrum disorders
 characterized by pervasive and
usually severe impairment of reciprocal
social interaction skills, communication
deviance, and restricted stereotypical
behavioral patterns.
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5. Pervasive Developmental Disorders
 this category of disorders also called
autism spectrum disorders
 characterized by pervasive and usually
severe impairment of reciprocal social
interaction skills, communication deviance,
and restricted stereotypical behavioral
patterns.
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 this category of disorders also called
autism spectrum disorders
 characterized by pervasive and
usually severe impairment of reciprocal
social interaction skills, communication
deviance, and restricted stereotypical
behavioral patterns.
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manifestations include:
Types of PDD a. little eye contact
b. make few facial expressions
1. AUTISTIC DISORDER
c. does not use gestures to communicate
 BEST KNOWN OF THE
d. does not relate to peers or others
PERVASIVE DEVELOPMENTAL
e. stereotyped motor behaviors such as hand -
DISORDER
flapping, body-twisting, and head banging.
 MORE IN BOYS THAN GIRLS  tx: special school (language & special education)
- haldol for tantrums & hyperactivity

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2. Rett’s disorder 3. Childhood Disintegrative disorder

 characterized by development of
multiple deficits after a period of normal
functioning.  characterized by marked
 occurs exclusively in girls, rare, and regression in multiple areas of
persists throughout life. functioning.
 after 5 months, child loss motor skills &
begins showing stereotyped movements.  onset 3 – 4 years
 tx: same as autism  occurs often in boys than girls

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Attention Deficit and Disruptive

4. Asperger’s disorder Behavior Disorders
 mild form of autism
> characterized by social aloofness, lack of interest in other
people, and an excessive preoccupation with a very specialized
interest but no language or cognitive delays.
 more often in boys than girls
 effects generally life long.

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Attention Deficit hyperactivity disorder Attention Deficit hyperactivity disorder

( ADHD ) ( ADHD )
> characterized by inattentiveness, over activity, > essential feature is persistent pattern of inattention
and impulsiveness and/or hyperactivity and impulsiveness.
> more common in boys > symptoms may occur around age 3, diagnosed
when the child begins preschool or school.

Tx: (Methylphenidate)Ritalin,
> Therapeutic play

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Interventions for ADHD Interventions for ADHD

• Ensuring the child’s safety & that of the others.
- Stop unsafe behavior. • Improved role performance
- Provide close supervision - Give positive feedback for meeting expectations.
- Give clear directions abut acceptable & unacceptable - Manage the environment (e.g., provide a quiet
behavior place free of distractions for task completion

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Interventions for ADHD Interventions for ADHD

• Structured daily routine
• Simplifying instructions/directions
- Establish a daily schedule
- Get child’s full attention
- Minimize changes
- Break complex asks into small steps
• Client/family education & support
- Allow breaks
- Listen to parent’s feeling & frustrations

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TREATMENT psychopharmacology

 NO one treatment have been found.  Methylphenidate (Ritalin) -70-80% effective

 The goal of treatment involve managing symptoms, reducing  Amphetamine compound (adderal)
anxiety & impulsivity and increasing the child’s attention
 Dextroamphetamine (Dexedrine) & pemoline (cylert) –
 Combination of pharmacotherapy with behavioral,
psychosocial & educational interventions.
stimulant

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B. Conduct Disorders B. Conduct Disorders

> characterized by persistent antisocial behavior.
> symptoms are clustered in 4 areas:
i. Aggression to people and animals
ii. Destruction of property
iii. Deceitfulness and theft
iv. Serious violation of rules
> disregard for the rights of others
and for rules, physical aggressiveness,
absence of guilt, irritability, low self-
esteem, stealing, trouble with the law.
> Duration of at least 6 months
> Onset before age 18

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Symptoms of conduct disorder

Aggressiion to people & animals Bullies, threatens, or intimidates
others
Physical fights Use of weapons
Forced sexual activity Cruelty to people or animals
Destruction of property Fire setting
Vandalism Deliberate property destruction
Classification of conduct disorder:
a. Mild – person has a few conduct problems.
b. Moderate – increase in conduct problems such
as harming others.
c. Severe – considerable harm to others

Deceitfulness & theft Lying

Treatment: family and individual therapy. Conflict
Shoplifting, Breaking into house, building or resolution, anger management, teach social skills
Truancy from school car
Cons other to avoid responsibility Serious violation of rules

Stays out overnight without parental consent Runs away from home overnight
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Interventions for Conduct Disorder Interventions for Conduct Disorder

• Decreasing violence & increasing compliance with treatment
- Protect others from client’s aggression & manipulation
- Set limits for unacceptable behavior
- Provide consistency with client’s treatment plan
- Use behavioral contracts
- Institute timeout
- Provide a routine schedule of daily activities
• Improving coping skills & self – esteem
- Show acceptance of the person, not necessarily
behavior
- Encourage the client to keep a diary
- Teach and practice problem-solving skills

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Intervention for conduct disorders C. Oppositional Defiant Disorder

• Promoting social interaction > uncooperative, defiant, and
- Teach age appropriate social skills hostile behavior toward
- Role-model & practice social skills authority figure without major
- Provide positive feedback for acceptable behavior antisocial behavior.
• Providing client and family education > expected in ages 2-3 years of
age and early adolescents

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TIC DISORDERS: 1. Tourette’s Disorder

Tic- a sudden, rapid, recurrent, non rhythmic,
stereotyped motor movement or vocalization.
Symptoms:
- blinking, jerking the neck, shrugging the
shoulders, grimacing, and coughing, clearing
the throat, grunting, sniffling, snorting and
barking.
- multiple motor and vocal tics.
- person has significant impairment in academic, social and
occupational areas and feels ashamed and self-
conscious.
- which occur many times a day for more than 1 year.
- The person has significant impairment in academic, social, or
occupational areas and feels ashamed and self-conscious.

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2. Chronic motor or Tic disorder

- motor or vocal tics are seen.

Treatment:
- risperidone (Rispedral)
- Olanzapine (Zyprexa)
- Plenty of rest and manage stress

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SEPARATION ANXIETY DISORDER

Other Disorders of Infancy,
Childhood or Adolescence
• Separation anxiety disorder is characterized
by anxiety exceeding that expected for
developmental level related to separation
from the home or those to whom the child
is attached (APA, 2000).
• Fear of separation may lead to avoidance
behaviors such as refusal to attend school
or go on errands.

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SELECTIVE MUTISM
• Selective mutism is characterized by persistent
failure to speak in social situations where
speaking is expected, such as school (APA, 2000).
• Children may communicate by gestures, nodding
or shaking the head, or occasionally one-syllable
vocalizations in a voice different from their
natural voice.

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• The disturbed social relatedness may be evidenced

REACTIVE ATTACHMENT DISORDER
• involves a markedly disturbed and
developmentally inappropriate social
relatedness in most situations.
• lack of selectivity in choice of attachment figures
• begins before 5 years of age and is
associated with grossly pathogenic care such
as parental neglect, abuse, or failure to meet
the child’s basic physical or emotional needs.
by the child’s failure to initiate or respond to social
interaction (inhibited type).
–the child will not cuddle or desire to be close to anyone.
(disinhibited type)
–the child’s response is the same to a stranger or to a
parent.

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STEREOTYPIC MOVEMENT DISORDER • include waving, rocking, twirling objects,

• is associated with many genetic, metabolic,
and neurologic disorders and often
accompanies mental retardation.
• involves repetitive motor behavior that is
nonfunctional and either interferes with
normal activities or results in self-injury
requiring medical treatment (APA, 2000).
biting fingernails, banging the head,
biting or hitting oneself, or picking at the
skin or body orifices.
• the more severe the retardation, the
higher the risk for self-injury behaviors.

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Thank you for

listening!
God Bless
everyone!

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