511: Psychiatric Nursing Care of Children and Adolescents

Dealing with frustration and unfavorable events. (a) Celebrating good things, feeling pleasure (b) Developmental stage? Task? (MPR-LRWC) Nursing care for deficit?

middle childhood, industry (a) middle childhood, physical skill development, peer relationships, learning to read, write, and calculate, development of morality and values (b) Help to cope with frustration using stories and play model cooperation, and reinforce cooperative behavior do not use shame or humiliation to gain control have fun with the child use community meetings for peer support and modeling use positive reinforcement for child's strengths and abilities.

Bio-psycho-social Assessment: Assessing Mental Disorders in Children and Adolescents: Similarities to mental disorders diagnosed in adulthood, but SXs may have been? The symptoms differ how? Treatment planning and therapeutic interventions must always occur in?

missed during child/adolescence years and not identified until early adulthood in presentation, developmental age, gender factors the context of the family and assume a multimodal, system's approach to care

Family advocacy refers to?

mutual support, time, energy, and resources needed to advocate for improved services and opportunities for family members with psychiatric illness.

What do you initiate for children with PTSD? MANDT?

(universal trauma precaution) A lot children are faced with PTSD Framework to work with patient. Trauma based for all patients. In this place and with these people I feel safe. The children and parents have to feel safe with us or we won't get anywhere

Human Development: Human development starts with____________ potential and develops through? in what environment? Areas of development?

Human development starts with genetic (nature) potential and develops through the interaction between the individual and the caring others (nurture) in the individual's environment Multiple area of development: physical, cognitive, social-emotional, familial

Autistic Spectrum Disorders (ASD) DSM 5 -Neurodevelopment Disorders: What type of disorder is it? A. Marked by? Sx? B. what type of behaviors and movements?

A profound disorder of relating and communicating persistent deficits in social communication and social interaction, across multiple contexts and settings 1. Social-emotional reciprocity 2. Non-verbal communicative behaviors 3. Developing, maintaining and understanding relationships Restricted, repetitive patterns of behavior, interests, movements, activities

What d/o consists of Persistent pattern of Inattention and /or Hyperactivity -Impulsivity that interferes with functioning or development? What age is this present?

ADHD Symptoms that negatively impact directly on: Social Academic "Occupational" activities Symptoms usually present before age 12

List the 5 Most Common Psychiatric Disorders in Childhood

ADHD Depression Anxiety Conduct Disorder Autism

A profound disorder of relating and communicating persistent deficits in social communication and social interaction, across multiple contexts and settings This is an example of?

ASD

What is Resilience? Factors?

Ability to withstand stress Affected by individual characteristics, early life experiences Protective factors in their environment Are competent, realistic, flexible, assured of their own inner resources and support Have strong sense of personal control, takes age-appropriate responsibility Recover quickly when faced with stressors

Theoretical views of adolescence: psychosocial cognitive

Adolescents attempt to establish an identity within the social environment. They try to coordinate self-security, intimacy, and sexual satisfaction in their relationships adolescence is an advanced stage of cognition in which the ability to reason goes beyond the concrete to more abstract thinking, described as formal operational thought

Children and ACEs

Adverse Childhood experiences

Symptoms of CD?

Aggressive towards people and animals Bullies, threatens, intimidates others Initiates fights Used a weapon (bat, brick, knife) Cruel to people, animals Stolen, confronts victim, mugging, etc Coerce someone sexually Destruction of property, fire starting Deceitfulness or theft Broken into someone's home, car, business Lies, cons Shoplifting, forgery Serious violations of rules Stays out at night, against parental rules, before age 13 Run away from home overnight at least twice Truancy (before age 13)

Assessment: What is different than that of an adult assessment? Allow more time for? Do you separate them from the parent? Do you spend time alone with them? What type of anxiety may they exhibit? Allow for? (2 points) What type of history do you take and how do you validate it?

Allow more time develop rapport Trust and put at ease Time alone with child Separation from parent Stranger anxiety Allow for developmental age and interests of child Allow for cognitive and language abilities of child Initial & Periodic Functional & Developmental History Validate History with Adult

Symptoms of ODD?

Angry / Irritable Mood Lose temper Easily annoyed, "touchy" Often angry, resentful Argumentative / Defiant behavior Argues with authority figures Actively defies or refuses to comply with requests / rules from authority figures Deliberately annoys others Blames others for his mistakes /misbehaviors Vindictiveness Spiteful or vindictive (at least twice in last 6mos)

d/o of relationships nursing dx?

Assess anger, spite, or loss of temper in exchanges with significant others.

Anxiety d/o nursing implications

Be specific when interacting with a child, The fears can extend to include situations for parents friends siblings or pets. Avoidance and vigilant behaviors may be noted. This child does not volunteer a lot of information about thoughts or feelings.

Adaptive sense of direction and purpose Developmental stage? Task? (CO) Nursing care for deficit?

Later adolescents preparation for occupation, civic responsibility Actively listen to and encourage the expression of needs and goals in community meetings, discuss relevant issues and life events help the child realistically assess ability and potential.

d/o of relationships Developmental factors

This area of problem behavior is not considered a mental illness but can become the focus of clinical attention developmental stage and norms are key to understanding the family or interpersonal dynamics

movement and tic d/o description simple and complex

Tics can be motor or vocal simple or complex Simple motor: grimaces, eye muscle twitches, abdominal tensing or jerking of shoulder, head or distal extremities Simple vocal- barks, coughs, throat clearing, sniffs, or single syllables called out Complex vocals have more organized patterns

Handling separation and independence Developmental stage? Task? (LAST) Nursing care for deficit?

Toddlers Autonomy, separation, toilet training, learning right from wrong offer exercise and motor activity, allow child to make choices, offer transitional object, take control if child is out of control, otherwise let them have some control, set limits and boundaries to help feel secure

T/F Ignore negative behavior in children when appropriate

True

mood d/o developmental factors: Depression manifests as _____________ in young children Mania manifests as? School age may have what complaints? Delusional content depends on?

Very young child expresses depression through irritability, somatic complaints, or refusal to go to school Manic symptoms are often misread for ADHD School ages may have somatic complaints (HA, stomachache, abdominal pain) Delusional content depends on the developmental stage Because the child has grown up with the d/o child may not voluntarily discuss symptoms with parents or teachers

Theoretical views of adolescence: cultural moral

Views adolescence as a time when a person believes that adult privileges are deserved but withheld. This stage ends when society gives the adolescent the full power and status of an adult Adolescents' moral development is how teens approach moral conflicts. Boys generally seek direct resolution and girls avoid conflicts to maintain a relationship.

Effective Therapies for CD: ____________________assessment and management needed List therapies

Vigorous early intervention Parent management therapy Multisystemic therapy Multidimensional foster care model Cognitive problem-solving skills training Anger control training Medications

Sensory Processing includes? what type of senses?

Visual Auditory Taste Smell Movement Muscle Awareness Interoception SBMD (dyspraxia) Motor Planning Sensory Discrimination Disorder

Therapeutic aspects of play: list the beneficial outcome of the therapeutic factor listed below. Overcoming resistance (WA) communication (U) competence (SE) creative thinking (PS) catharsis (ER) abreaction (PTE) role playing (NB)

Working alliance understanding self-esteem problem solving emotional release perspective on traumatic event learning new behaviors

What is Dyspraxia? What may it affect?

a form of developmental coordination disorder affecting fine or gross motor coordination. It may affect speech.

mood d/o description

a pattern of illness caused by abnormal mood. Episodes refer to any period of time the child is abnormally happy or sad or has uncontrollable mood swings.

Protective Factors: Protective or resiliency factors make some children more resilient than others Sense of ____________developed an internal standard _______________distance oneself from dysfunctional family, transcend diff past Not identify with whom? Select healthy alternatives when?

autonomy, "agency", Adaptive distancing: distance oneself from dysfunctional family, transcend diff past Not identify with troubled family members Select healthy alternatives when available

Protective Factors: ___________ competence Temperament characteristics that elicit? Positive? Surrounded by whom? Opportunities that allow?

positive responses from others Positive self-esteem, self-confidence Supportive adults who foster trust Opportunities that allow competencies to be reinforced and rewarded

Child Interview: Whats the most important thing to develop here? What may the child not respond to what types of communication? Convey what to the child? Use what types of communication?

establish therapeutic alliance with child and parents Child may not respond to problem-centered lines of communication, so discuss more general aspects of child's life (family members, school, friends) Convey respect and authenticity, use familiar vocabulary at child's level of understanding Use nonverbal communication and alternatives to verbalization (eye contact, reassuring facial expressions)

Handling joint decisions and interpersonal conflicts Developmental stage? Task? (DISTS) Nursing care for deficit?

preschoolers initiative, tolerance of others, sexual identity, socialization, developing a conscience set up opportunities for problem solving and cooperative thinking help id fears through books, art, and play shape appropriate socialization using reinforcement become model for conflict resolution

5 stages of adolescent substance abuse list 2

psychological pr physical dependency- selling to support the habit, possibly stealing or prostitution in exchange for drugs, daily use behavior is pathological lying; school failure, family fights, involvement with the law over curfew, truancy, vandalism, shoplifting, DUI, B&E, and violence tx: Inpatient programs and family involvement using drugs to feel normal- any way possible, all day behavior is drifting, with repeated failures and psychological symptoms of paranoia and aggression, frequent OD, blackouts, amnesia, chronic cough, fatigue tx: inpatient programs and family

List d/o of relationships

separation anxiety, reactive attachment of infancy or early childhood, parent-child relation problem, sibling relational problem, problems r/t abuse or neglect

movement and tic d/o, when is it suppressed? Other assessments?

usually suppressed during sleep, increase in intensity or frequency at times of stress, fatigue, or illness present a wide range of symptoms on a continuum from occasional eye blinking to severe motor and vocal tics so severe they preclude normal classroom participation.

ADHD: ______% of US children have ADHD? Much more common in whom? Average age of onset? Mean age of Dx? ________% will have symptoms persisting into adulthood? symptoms are more persistent than ______________ symptoms? risk factors?

3-5 boys than girls Average onset is 3yrs, mean age of diagnosis is 9yrs Approx 60% Inattention symptoms are more persistent than hyperactivity / impulsivity symptoms risk factors: genetic loading (ADHD, mood and anxiety disorders), pregnancy and perinatal complications, family conflict

Statistics: How many children under 18 have psychiatric disorders? How many have a clinically significant psychiatric disorder that should be treated? How many receive tx? Childhood neuro-psychiatric disorders predicted to increase by more than _____% internationally to become one of the 5 most common causes of morbidity, mortality, and disability among children in the world

8 1:5 20-25% 50

What is Kudzu?

CAM: plant that has diadzin, daidzein, and puerain. Has effects on ETOH Diadzin inhibits Aldehyde Dehydrogenase, the enzyme that metabolizes ETOH May reduce desire to drink

A Note about Sensory Processing Disorder SPD: SP refers to the way in which the __________ and _________ manage incoming sensory information. Components of SP? T/F: All children with ASD don't have SP challenges, but all children or adults who have SPD are autistic.

CNS and the PNS Reception, modulation, integration, and organization of sensory stimuli, including the behavioral responses to sensory input False All children with ASD have SP challenges, but not all children or adults who have SPD are autistic.

Developmental Course of CD: Can see as early as? ODD is a common precursor to? Rare emergence after age? Commonly remits by? Early onset predicts? At risk for?

Can see as early as pre-school, but usually between middle childhood thru middle adolescence ODD is a common precursor to Childhood onset CD Rare emergence after age 16 Commonly remits by adulthood Early onset predicts worse prognosis, increased risk of criminal behavior, CD, substance abuse in adulthood At risk for mood, psychotic, somatic symptom disorders

movement and tic d/o Nursing implications

Child with a tic feels out of control of own body. With tourettes d/o the child has multiple motor tics in addition to vocal ones and may use socially inappropriate, vulgar language (coprolalia)

Subtypes of CD: Child-onset: before age? 1 symptom of CD prior to age? Adolescent on-set: after age? Symptoms? Unspecified? Limited? S/S?

Child-onset: before age 10 1 symptom of CD prior to age 10 Adolescent on-set: after age 10 no symptoms of CD shown prior to age 10 Unspecified: ? Don't know when symptoms started Limited Pro-Social Emotions Lack of remorse or guilt Callous, lacks empathy Unconcerned about performance Shallow or deficient affect Mild, moderate, severe

Anxiety developmental factors Children often lack? Feel? Symptoms?

Children often lack the insight that they feel anxious and express symptoms by clinging crying or freezing in position. Important to remember that anxiety is normal even useful emotion that will change from one developmental stage to the next young children are especially apt to experience PTSD symptoms by talking less and acting out their anxieties

Therapeutic aspects of play: list the beneficial outcome of the therapeutic factor listed below. fantasy (C) teaching through metaphors (I) relationship enhancement (T) mastering developmental fears (GD) game play (S)

Compensation and sublimation insight trust in others growth and development socialization

Repetitive / persistent pattern of behavior that violate the basic rights of others or societal norms and rules. This is indicative of what disorder?

Conduct Disorder

Useful Interventions?

DIR/FloorTime (Directed) Therapeutic Play Expressive Therapy, Art Bibliotherapy, Social Stories StoryTelling Jim early used Basketball

____________________is a complex phenomenon, whose elements result in a whole person, but no single theory of Child Development satisfactorily explains it.

Development

Working for delayed gratification Developmental stage? Task? (IR) Nursing care for deficit?

Early adolescence identity and role acceptance use daily expectations and games to teach delayed gratification encourage self-reinforcement

Autism Interventions: What's the key? What therapies to improve functioning and reduce maladaptive behaviors? education and participation of whom is essential? What therapy to improve communication abilities? What therapy to improve sensory integration and motor abilities? What medications can be helpful to treat severe symptoms of aggression, self-injurious behavior, hyperactivity, and obsessive behaviors?

Early identification, and initiation of intensive interventions Behavioral and Developmentally-Based Parent Speech and Language Occupational Appropriate school placement with highly structured and supportive approach Antipsychotics, antidepressants, naltrexone, clonidine, and stimulants

Video: 3 developmental features indicative of ASD?

Effective communication in sharing enjoyment- Shifts gaze from toy to person to share attention. Shares enjoyment by looking and smiling. Coordinates gaze, vocalization, and gesture to communicate Making social connections- mild motor delay child in video, looks in response to bid to share attention. Socially engaged. Coordinates gaze, vocalization, and gesture to communicate. can follow pointing, and continues topic of conversation, motivation to communicate with others, Shares enjoyment by looking and smiling. Seeing social opportunity through play- Engages others in play, Shows meaningful, purposeful, and pretend play. Shares enjoyment and smiling with others. Synchronizes with others through imitation. Pay attention to many things at once, shows enjoyments, linkages, imitation, help learn new play skills and synchronize actions with others

Nursing Interventions Encourage? Use? Engage in? Develop? What is an emergent problem?

Encourage to identify and verbalize feelings Use distraction techniques for destructive feelings deep breathing, positive imagery, snapping rubber band on the wrist Engage in stress management techniques that reduce impulsivity counting to 10, re-evaluation, "thought stopping" Develop enhanced social skills If suicidal ideation-emergency interventions needed

d/o of relationships assessment

Examine family hx for duration and intensity of current problem, Is the interaction difficulty only with one adult and not all adults? All family members involved should be interviewed. A most common occurrence in child mental health practice

Anxiety d/o Assessment

Fears are common in children but in 2-3% they cause clinical level distress. Children usually only believe the traumatic incident in dreams'Children exhibit compulsions more frequently than obsessions Although equally affected, boys symptoms begin at an earlier age than girls

Psychopharmacology - Adolescent: Is this age group frequently included in clinical trials? What is their metabolism like? Dosing regimens? What prescriptions are part of comprehensive treatment plan? What meds are preferred over TCAs? Why?

Few clinical drug trials in adolescents Adolescents are neither children nor adults Metabolism more like adults than children Dosing regimens usually closer to adults Cannot assume drug response will be within generally expected range for adults Prescribe medications as necessary is part of comprehensive treatment plan SSRIs generally preferred over tricyclic antidepressants (TCAs) because of lower side effect profile, relative safety in overdose

ADHD - Symptoms of Hyperactivity - Impulsivity?

Fidgets and squirms Inability to stay seated General restlessness, runs and climbs where inappropriate Difficulty engaging in leisure activities quietly Always "on the go" Excessive talking Blurting out answers before question is finished Difficulty waiting his turn Interrupting or intruding on others

d/o of intake ad elimination Nursing implication

For eating d/o direct observation of the child and parents at mealtime may help. Most information will come in verbal reports from the parent Watch for other oral behaviors (nail biting and thumb sucking)

Mood d/o Nursing implication

Full assessment for self harm and contract for safety Establish a safe environment monitor sleeping eating pattern and medications Educate the child about effects of compliance work with the parents to foster support for the child

All psychiatric disorders of Childhood and Adolescents should be viewed within the context of?

Growth and Development

ASD: Impairment with? Lack of? Inflexible adherence to?

Impairment with social interaction, communication, and behavior peer relationships specific non-functional routines and repetitive, stereotypic motor mannerisms

d/o of relationships Description

Inappropriate and excessive anxiety about separation from home or significant person Parent child dx is relevant when clinically important symptoms or negative effects on functioning are linked with the way a child and parent interact

Attention Deficit Hyperactivity Disorder (ADHD) DSM 5 -Neurodevelopment Disorders Persistent pattern of? Characterized by?

Inattention and /or Hyperactivity -Impulsivity that interferes with functioning or development

ADHD - Symptoms of Inattention?

Inattentive to details, careless mistakes Difficulty sustaining attention and focus Seeming not to listen, mind wanders Failure to finish tasks, may start task but not finish, sidetracked Difficulty w/organizing, messy, poor time management Avoidance of tasks requiring sustained attention Loss of things, homework, glasses, materials for school Distractibility Forgetfulness

Trusting, closeness, relationship building Developmental stage? Task? (WAFTT) Nursing care for deficit?

Infancy Trust, attachment, learning to walk, talk, and feed self Encourage interaction, use face to face, use touch, offer food and transitional objects, be attentive w/o being intrusive, nurture, attempt to connect family to child, develop relationship through play

Child Interview: What might you want to repeat back to the child? What might you do to foster relationship? What type of play works best? If you are initiating storytelling how would you do it?

Interpret nonverbal cues back to child verbally Use humor and active listening to foster relationship, be creative, use unstructured play Use indirect age-appropriate storytelling, picture drawing, creative writing

List mood d/o

MDD, BP I or II, Dysthymic, Mixed episode, Hypomanic, mood d/o caused by medical condition, substance induced

ADHD: In NIMH's Multi-modal Treatment of Children with ADHD (MTA) study: ______________if started early enough and with optimal intensity, demonstrated long-term improvement. Most children receiving a variety of interventions had sustained improvement after how much time? What are they still at risk for? Less favorable outcome for whom? What yields significant improvement in behavior and academic performance? What is Contingency?

Medication 3 years, but still at higher risk for behavioral, delinquency and substance abuse problems. for those with associated CD or untreated depression. Systematic combination of direct contingency management plus clinical behavioral therapy an event you can't be sure will happen or not

Mood d/o assessment

Mental status exam Explore family, particularly parental hx of mood d/o Environmental precipitants of traumatic event in young child Recurrence or rehospitalization within 2 years

movement and tic d/o Developmental factors?

Motor tics appear as young as 2 and usually involve the upper part of the face; vocal occurs somewhat later. Prognosis for transient tics is better; chronic motor vocal tics wane within a few years and rarely last

d/o of intake ad elimination Developmental factors

Normal toddlers put everything in their mouth. Pica should not be considered unless inappropriate eating lasts longer that one month in a child developmentally past the toddler stage. Focus on the involuntary nature of the problem as well as the hope for improvement from the child Build a therapeutic alliance by using the childs own words for body function and anatomy.

Pattern of angry, irritable mood, argumentative, defiant behavior, or vindictiveness is what disorder?

Oppositional Defiant Disorder (ODD)

List Anxiety d/o

Panic d/o, Agoraphobia, specific phobia, social phobia, OCD, acute stress d/o, GAD, anxiety by medication, substance induced, anxiety d/o NOS

Oppositional Defiant Disorder (ODD) DSM 5 - Disruptive, Impulse-Control, and Conduct Disorders Pattern of? When?

Pattern of angry, irritable mood, argumentative, defiant behavior, or vindictiveness **while interacting with an individual not a sibling

Antisocial Personality Disorder is classified as a pattern of? What age? Some s/s? Have to be at least what age? Evidence of what before 15yo? Occurrence of antisocial behavior is not exclusively during course of what two d/os?

Pattern of disregard for and violation of the rights of others, occurring since age 15 Failure to conform to social norms, grounds for arrest Deceitfulness, lying, conning others for personal profit or gain Impulsivity, failure to plan ahead Irritability and aggressiveness, fighting, assaults Reckless disregard for self or others safety Consistent irresponsibility to sustain work or honor financial obligations Lack remorse, indifferent or rationalize hurting others Be at least 18yrs old Evidence of CD with on-set before age 15 Occurrence of antisocial behavior is not exclusively during course of schizophrenia or BPD

Piaget- stages of? Erikson? Gesell? Kohlberg? Bowlby? Greenspan? What is included in neurodevelopment?

Piaget- stages of neurological/cognitive maturation (sensorimotor, causality) Erikson- stages of emotional tasks and development Gesell- stages of physical, cognitive and psychological development Kohlberg- stages of moral development Bowlby- attachment and bonding process in relationships if interrupted in 1st 2 years would be a problem. Flack from working mothers. Research found not true Greenspan -social-emotional development (DIR/FloorTime) ACE study Neurodevelopment -sensory, motor, language, cognition Sensory Processing (Lucy Miller)

List d/o of intake ad elimination

Pica, rumination, feeding d/o of infancy or early childhood, enuresis, encopresis, other eating d/o's anorexia bulimia,

Related Variables: Prenatal and Perinatal variables? Environmental?

Pregnancy and delivery complications, infections, viruses, rubella, maternal alcohol and drug use, poor maternal nutrition, familial genetic patterns, mother-baby bonding and interaction patterns. family patterns of perception and capacities, child rearing techniques and expectations, individual differences

ADHD Interventions?

Psychopharmacology Behavioral and CBT Programs Social Skills Training / Groups Individual and Family Therapy Collaborate with School

Conduct Disorder (CD) DSM 5 - Disruptive, Impulse-Control Disorders?

Repetitive / persistent pattern of behavior that violate the basic rights of others or societal norms and rules

Legal / Ethical: What is rarely granted to child apart from parents? Provider balances what against parent's requests? What do you report? Mandate to report to authorities any information about?

Right to privacy and confidentiality rarely granted to child apart from parents Provider balances child's wishes and interests against parent's request for information Report plan to self-harm/harm to others Mandate to report to authorities any information about child sexual or physical abuse Social workers from the tx team mostly.

Psychopharmacology - Adolescent: What medications are effective in tx adolescent OCD and anxiety d/o's? ______________for anxiety generally not recommended in this age-group because of increase in drug experimentation, possible negative effects on? _____________generally well tolerated in this age-group; effective in treating mania, aggression, conduct disorder ____________are standard treatment for psychotic symptoms in adolescents Adolescents have positive response to _________ for ADHD, similar to that of children

SSRIs effective in treating adolescent obsessive-compulsive disorder and some anxiety disorders, e.g., panic disorder Benzodiazepines learning and memory Lithium Other mood stabilizers not well studied in adolescents Antipsychotics psychostimulants

Other mental disorders and special issues of childhood and adolescence?

Self Harm Anxiety Depression Suicidal Ideation OCD Selective Mutism Tic Disorders Disorders of Elimination

Adolescent Interview: Influences on therapeutic communication: How might the adolescent act? What may they do? Defenses are often seen how? How would you limit acting out? What may be interfering with their happiness? How can you help with this? What would you point out?

Silence, Confidentiality, Negativism, Resistance, Arguing, Testing, Bringing friends, Embarrassment about being in therapy Defenses often seen in rebelliousness, passivity, shyness, negativism, intellectualization Adolescents tend to act out, avoid examining thoughts and feelings Limit acting out: -point out how it interferes with therapeutic process -Point out adolescent's tendencies to be judgmental and self-critical Automatic thoughts/inner feelings interfering with happiness -Point out tendency to see in extremes, encourage emotional catharsis, be alert to defenses of denial and reaction formation

three ways to take the bark out of bullies?

Speak up- after teen talks about bully. go to school talk to teachers coaches and principal parents or adults in charge observe your own behavior- adolescents look to adults for cues about how to act Advocate- for policies and programs concerning bullying in the schools and community

d/o of intake ad elimination assessment

Symptoms of elimination may be embarrassing. Assess for pain, sensation of need to void. A few years of maturation can separate the pathological from the developmental issue

Anxiety D/o description: child presents with? symptoms produce? _______________is the rule? Anxiety symptoms can be found in a child with almost any other?

child presents with prominent anxiety symptoms. symptoms produce disability or distress co morbidity is the rule. Anxiety symptoms can be found in a child with almost any other Axis 1 d/o (can be part of mood d/o or separation anxiety)

5 stages of adolescent substance abuse list 3

curiosity- available but not used, behavior is risk taking and desired acceptance tx anticipatory guidance to develop good coping and strong self esteem. clear family guidance on drugs and ETOH Experimentation- house supply, friends, siblings. may have weekend use for recreation behavior is lying or little change. tx: drug education, attention to societal messages, reduction of supply, strict loving rules, drug free alternative activities regular use- buying, progresses to mid-week use, purpose is to get high (excitement followed by guilt) behavior is mood swings, poor school performance, truancy, change in peer groups tx: drug free self help groups family involvement, psychiatric counseling

List movement and tic d/o

developmental coordination, transient tic, chronic motor or vocal tic, tourette d/o, stereotypic movement d/o, tic d/o NOS

Mental Status Exam: Observe child from a _____________perspective

developmental perspective Example: depression may be confused with shyness

Oppositional Defiant Disorder (ODD) Symptoms can appear when? Does ODD become OC? These patients are at risk for? Higher risk for? 2 of the most common co-occuring d/os with ODD?

during pre-school years but rarely later than early adolescence Not pre-ordained that ODD becomes CD development of mood disorders antisocial behavior, impulse-control problems, substance abuse, anxiety, depression ADHD and CD, and increased risk of suicide.

relaxing and playing Developmental stage? Task? Nursing care for deficit?

early adolescents new relations with peers of both genders encourage playfulness at appropriate times

Theoretical views of adolescence: biological psychoanalytical

emphasis is on physical growth, behavior, and environment, which influence feelings, thoughts and actions puberty is called the genital stage, in which sexual interest is awakened. Biological changes upset the balance between the ego and ID, and new solutions must be negotiated

ASD: A neuro-biological disorder characterized by? Onset of symptoms usually occurs before? Ratio of male to female? Likely involves imbalances of? Where are the brain abnormalities? More common in children with? risk factors?

marked impairment of communication (language), social and cognitive abilities age 3 4:1 males to females, possibly 1:150 incidence in US glutamate, serotonin, and GABA, abnormalities of amygdale, hippocampus, and cerebellum, and abnormalities in neuron cell migration and pruning family history of pervasive developmental disorders risk factors: male, severe MR, genetic loading

Genetic load is the difference between?

the presence of unfavorable genetic material in the genes of a population

d/o of intake ad elimination description

intake: child eats non nutrient substances, regurgitates and rechews food, or fails to eat enough. Elimination: Urinating on clothes or bed after 5yo Repeated passage of feces in inappropriate places after 4 y/o Enuresis is the most often viewed as physiological condition with physical symptoms, not necessarily mental d/o. It does have emotional sequelae similar to obesity

cognitive processing Developmental stage? Task? (EEI) Nursing care for deficit?

later adolescents emotional and economic independence from parents offer games that use cognitive processing discuss abstractions, such as the moral of stories or movies

Psychopharmacology - Child: how do children metabolize and eliminate medications? Can they receive adult doses? What is used to treat psychiatric disorders in children?

metabolize and eliminate medications more rapidly than adults Although initial doses may be low, doses can ultimately be as high as those for adults, requiring frequent clinical and laboratory follow-up Anxiolytics, antidepressants, mood stabilizers, and antipsychotics all used to treat psychiatric disorders in children

Family therapy refers to both?

specific-family interventions and broader conceptual framework for intervention that includes family-centered treatment, family and couples psychotherapy, family skills building, multiple family groups, and in home support.