CHILD and

ADOLESCENT
DISORDERS
Prepared By: Bella Faith Masong, MAN
Learning Objectives:
Discuss the characteristics, risk factors, and family dynamics of
psychiatric disorders of childhood and adolescence.

Apply the nursing process to the care of children and adolescents

with psychiatric disorders and their families.

Provide education to clients, families, teachers, caregivers, and

community members for young clients with psychiatric disorders.
DISORDERS FIRST DIAGNOSED IN INFANCY, CHILDHOOD, AND ADOLESCENCE
Facts:
MENTAL RETARDATION ATTENTION-DEFICIT AND DISRUPTIVE BEHAVIOR
• Mild DISORDERS
• Moderate • Attention deficit hyperactivity disorder
• Severe • Conduct disorder
• Profound • Oppositional defiant disorder

LEARNING DISORDERS
• Reading disorder
Generally undiagnosed and undertreated
FEEDING AND EATING DISORDERS
• Pica
• Rumination disorder
• Mathematics disorder • Feeding disorder of infancy or early childhood
• Disorder of written expression
Diagnosis depends on
TIC behavior
DISORDERS appropriate for
MOTOR SKILLS DISORDER • Tourette’s disorder
agedisorder
• Developmental coordination • Chronic motor or tic disorder
• Transient tic disorder
COMMUNICATION DISORDERS
• Expressive language disorder ELIMINATION DISORDERS
Developmental theory is basic to understanding
• Mixed receptive and expressive language disorder
• Phonologic disorder
• Encopresis
• Enuresis
• Stuttering of the disorder OTHER DISORDERS OF INFANCY, CHILDHOOD,
OR ADOLESCENCE
PERVASIVE DEVELOPMENTAL DISORDERS
• Separation anxiety disorder
• Autistic disorder
• Selective mutism
• Rett’s disorder
• Reactive attachment disorder
• Childhood disintegrative disorder • Stereotypic movement disorder
• Asperger’s disorder
Mental Retardation
Definition:
Mental Retardation refers to
significantly sub-average general
intellectual functioning, resulting in or
associated with, concurrent
impairments in adaptive behavior and
manifested during the developmental
period.
Levels of Mental Retardation
Learning Disorder
Learning problems interfere with academic
achievement and life activities requiring
reading, math, or writing (APA, 2000)

Reading Disorder:(Dyslexia)
Mathematical Disorder: (Dyscalculia)
Writing Disorder: (Dysgraphia)

Low self-esteem and poor social skills are

common
Motor Skills Disorder
Developmental Coordination disorder
Impairment in the development of
motor coordination
Not due to general medical condition
(Cerebral Palsy, Muscular Dystrophy)
Marked delays in achieving motor
milestones (Walking, crawling, sitting),
dropping things, clumsiness, poor
performance in sports.
Communication Disorder
Expressive Language Disorder
- The difficulties with expressive language
interfere with academic or occupational
achievement or with social communication

Phonological Disorder
- Failure to use developmentally expected
speech sounds that are appropriate for the
individuals age and dialect Errors in sound
production, substitutions of one sound for
another (Use T for K), omissions of sounds
Stuttering

- Disturbance in the normal fluency and

time patterning of speech that is
inappropriate for the individual’s age.
- Frequent repetitions/ prolongations of
sounds or syllables
- Monosyllabic whole word repetitions (I-I-
I-I- see him)
PERVASIVE DEVELOPMENTAL DISORDER
Autism Spectrum Disorders

Impairment in several areas of

development
- Reciprocal social interaction skills
- Communication skills
- Presence of stereotype
behavior/interest/activities
Types PDD
Autistic Disorder
Rett's Disorder
Childhood Disintegrative Disorder
Asperger's Disorder
 Autistic Disorder
● Onset Prior to age 3 years
● More frequent in males/boys
● Average or above average of
intelligence with uneven
cognitive skills.
 Autistic Disorder
● Onset Prior to age 3 years
● More frequent in males/boys
● Average or above average of
intelligence with uneven
cognitive skills.
Symptoms
● Qualitative impairment in social
interaction
● Qualitative impairments in
communication
● Restricted repetitive and
stereotyped pattern of behaviors,
interests and activities
Causes
● Genetic
● Prenatal environment
● Perinatal environment
● Postnatal environment
 Rett's Disorder
● Is a rare genetic neurological and developmental
disorder that affects the way the brain develops,
causing a progressive inability to use muscles
for eye and body movements and speech.
● It occurs almost exclusively in girls.
● Develops between birth and 5 months of age.
● Is a genetic disorder.
Symptoms
● A slowing of head growth is one of the first
events in Rett syndrome
● Problems with muscles and coordination
● The child loses any purposeful use of her hands
● Stops talking and develops extreme social
anxiety and withdrawal or disinterest in other
people
 Childhood Disintegrative Disorder
● Also known as Heller's syndrome.
● It's a very rare condition in which children
develop normally until at least two years
of age, but then demonstrate a severe loss
of social, communication and other skills.
● Onset between age 3 or 4
 Childhood Disintegrative Disorder
● A child who is affected loses:
- Communication skills
- Nonverbal behaviors
- Skills they had already learned
Symptoms
● Delay or lack of spoken language
● Impairment in nonverbal behaviors
● Inability to start or maintain a conversation
● Lack of play
● Loss of bowel and bladder control
● Loss of language or communication skills
● Loss of motor skills
● Loss of social skills
● Problems forming relationships with other
children and family members
 Asperger’s Disorder
● A pervasive developmental disorder by the
same impairment of social interaction and
restricted stereotyped behaviors seen in
autistic disorder.
● No language or cognitive delays
● A rare disorder
Symptoms
● Problems with social skills
● Eccentric or repetitive behaviors
● Unusual preoccupations or rituals
– Ex: getting dressed in a specific order
● Communication difficulties
● Limited range of interests
● Coordination problems
● Skilled or talented
 ATTENTION DEFICIT
AND DISRUPTIVE
BEHAVIOR DISORDERS
 CASE STUDY
Lisa's son Jack had always been a handful. Even as a
preschooler, he would tear through the house like a tornado,
shouting, roughhousing, and climbing the furniture. No toy or
activity ever held his interest for more than a few minutes
and he would often dart off without warning, seemingly
unaware of the dangers of a busy street or a crowded mall.
It was exhausting to parent Jack, but Lisa hadn't been too
concerned back then. Boys will be boys, she figured. But at
age 8, he was no easier to handle. It was a struggle to get
Jack to settle down long enough to complete even the
simplest tasks, from chores to homework. When his teacher's
comments about his inattention and disruptive behavior in
class became too frequent to ignore.
ATTENTION DEFICIT HYPERACTIVITY DISORDER

Disorder characterized by persistent

pattern of:
- Inattentiveness

- Hyperactivity

- Impulsiveness

Occurs before age 7 y/o: BOYS

Etiology
● Hereditary
● Early alteration of embryonic
development
● Maternal alcohol intake
● Pregnancy or perinatal problems
● Environmental influence
● Nutritional deficiencies
● Lead poisoning
 DSM-IV-TR DIAGNOSTIC CRITERIA:
Symptoms of ADHD
Inattentive Behaviors Hyperactive/Impulsive Behaviors

- Misses details - Fidgets

- Makes careless mistakes - Often leaves seat (e.g., during a meal)
- Has difficulty sustaining attention - Runs or climbs excessively
- Doesn’t seem to listen - Can’t play quietly
- Does not follow through on chores or - Is always on the go; driven
homework - Talks excessively
- Has difficulty with organization
- Blurts out answers
- Avoids tasks requiring mental effort
- Interrupts
- Often loses necessary things
- Can’t wait for turn
- Is easily distracted by other stimuli
- Is intrusive with siblings/playmates
- Is often forgetful in daily activities
Adapted from American Psychiatric Association. (2000). DSM-IV-TR.
NURSING MANAGEMENT
Assessment
- History
- General Appearance and Motor Behavior
- Mood and affect
- Thought Process and content
- Sensorium and Intellectual Processes
- Judgment and insight
- Self-concept
- Roles and relationship
- Physiologic and Self-care Considerations
Nursing Diagnosis

- Risk for Injury

- Ineffective Role Performance
- Impaired Social Interaction
- Compromised Family Coping
Nursing Intervention
- Ensure Safety
- Positive reinforcement
- Simplify instructions and directions
- Structured daily routine
- CONSISTENCY
- Client and family education and support
CONDUCT DISORDER

Characterized by persistent
antisocial behavior in children and
adolescents that significantly
impairs their ability to function in
social, academic or occupational
areas
Symptoms are clustered in Four areas:

- Aggression to people and animals

- Destruction of property
- Deceitfulness & Theft
- Serious violation of rules
 Types of Conduct Disorder
Conduct disorder are categorized according to the age at which
symptoms of the disorder first occur:

Childhood- onset type occurs when the signs

of conduct disorder appear before age 10.

Adolescent onset type occurs when the signs

of conduct disorder appear during the teenage
years.
Conduct disorder can be classified as:
Mild
- Minor harm to others
- Example: lying, truancy, staying out
late without permission
Moderate
- Conduct problems increases
- Example: vandalism and theft
Severe
- considerable harm to others
- Example: Forced sex, cruelty to animals,
use of weapon, burglary and robbery
Symptoms
● Aggression to people and ● Deceitfulness and theft
animals ● Lying
● Bullies, threatens, or intimidates ● Shoplifting
others ● Breaking into house, building, or
● Physical fights car
● Use of weapons ● Cons others to avoid
● Forced sexual activity responsibility
● Cruelty to people or animals ● Serious violation of rules
● Destruction of property ● Stays out overnight without
● Fire setting parental consent
● Vandalism ● Runs away from home overnight
● Deliberate property destruction ● Truancy from school
Causes
● Genetic Factors
● Organic factors - brain damage
● Biochemical factors
● Psychosocial Factors
- child abuse
- a dysfunctional family
- parents who abuse drugs or alcohol
- Poverty
- Parental rejection
Treatment
● Drugs may include: ● Guidance and counseling
- Anticonvulsants ● Social skill training
- Role playing
- Lithium
- Modelling
- Antipsychotics
- Shaping of behavior
● Psychotherapy
NURSING MANAGEMENT
Assessment
- History
- General Appearance and Motor Behavior
- Mood and affect
- Thought Process and content
- Sensorium and Intellectual Processes
- Judgment and insight
- Self-concept
- Roles and relationship
- Physiologic and Self-care Considerations
Nursing Diagnosis

- Risk for other- Directed Disorder

- Noncompliance
- Ineffective Coping
- Impaired Social Interaction
- Chronic Low Self-esteem
Nursing Intervention
- Set limits on unacceptable behavior
- Show acceptance
- Do not be judgmental
- Social skills promotion
- Client and family education and support
Thank you