Exam 4 (psych nursing)

Which statement made by a 9yo child after hitting a classmate is a typical comment associated with childhood conduct disorder? "I'm sorry, I won't hit him again "He deserved it for being a sissy "I didn't think I hit him very hard "He hit me first, You just didn't see it

"He deserved it for being a sissy

Which statement demonstrates a well-structured attempt at limit setting? "Hitting me when you're angry is unacceptable "I expect you to behave yourself during dinner "Come here, right now! "Good boys don't bite

"Hitting me when you're angry is unacceptable

What assessment question should the nurse ask when attempting to determine a teen's mental health resilience? (SATA) "How did you cope when your father deployed for over a year to Iraq? "Who did you go to for advice while your father was away for a year in Iraq? "How do you feel about talking to a mental health counselor? "Where do you see yourself in 10 years? "Do you like the school you go to?

"How did you cope when your father deployed for over a year to Iraq? "Who did you go to for advice while your father was away for a year in Iraq? "Where do you see yourself in 10 years?

A child diagnosed with attention deficit hyperactivity disorder (ADHD) is reprimanded for taking the nurse's pen without asking first. He responds by shouting, "You don't like me! You won't let me have anything, even a pen!" The nurse is most therapeutic when responding with which statement? "I do like you, but I don't like it when you grab my pen." "Liking you has nothing to do with whether I will loan you my pen." "It sounds as though you are feeling helpless and insecure." "You must ask for permission before taking someone else's things."

"I do like you, but I don't like it when you grab my pen."

CBT is going well when a 12-yo pt in therapy reports to the NP: "I was so mad I wanted to hit my mother "I thought that everyone at school hated me. That's not true. Most people like me and I have a friend named Todd "I forgot you told me to breathe when I become angry "I scream as loud as I can when the train goes by the house

"I thought that everyone at school hated me. That's not true. Most people like me and I have a friend named Todd

The mother of a 3-year-old boy just diagnosed with autism spectrum is tearful and states, "The doctor said we need to start therapy right away. I just don't understand how helpful it will be—he's only 3 years old!" What response should the nurse provide to the mother's statement? "You are right, 3 years old is very young to start therapy, but it will make you feel better to be doing something." "Starting him on treatment now gives Taylor a much greater chance for a productive life." "If your child starts therapy now, he will be able to stop therapy sooner." "If you have questions, its best to ask the doctor."

"Starting him on treatment now gives Taylor a much greater chance for a productive life."

Claude is anew nurse to the psychiatric unit. He asks a senior nurse on staff for the best advice when working with oppositional defiant disorder. Which statement reflects advice on solid therapeutic communication? "When correcting behavior, use a loud firm tone "Use language beyond the patient's education level "When setting limits, be specific and outline consequences "An aggressive body language will make the patients respect your position

"When setting limits, be specific and outline consequences

*===Conduct Disorder===* Mild, moderate, severe **NO REMORSE or GUILT, EXCEPT WHEN FACING PUNISHMENT** -abnormally aggressive behavior; rights of others violated, destroy property, fights/bullying, may *beat parents* -breaks laws, *stealing* -Predisposing factors: chaotic home life, large family size, absent or alcoholic father -*Pyromania / Kleptomania* -MEDS: 2nd Gen (atypical) antipsychotics ......Risper*idone* .....Olanz*apine* .....Queti*apine* .....Zipras*idone* ..... Aripiprazole (turn)

*===Childhood Onset Conduct Disorder===* prior to age *10* -males: little concern for others (people/animals); lack of feelings of guilt or remorse; feel actions are justified; low self-esteem *===Adolescent Onset Conduct Disorder===* after age *10* -callous, or the unemotional *bully* -early onset sexual behavior (may rape), substance abuse -males: fight, steal, vandalize -females: lie, truant, run away, prostitution, aggression

Medication for Conduct Disorder that exhibit aggression, impulsivity, hyperactivity, and mood symptoms would be what classification?

2nd Gen Antipsychotics (atypical) -Risper*idone* -Olanz*apine* -Queti*apine* -Zipras*idone* -Aripiprazole

Autism typically occurs within the first ____ years of life, yielding deficits in social interaction and communication skills.

3

Which child is demonstrating behaviors that support a diagnosis of adolescent onset conduct disorder? A 12-year-old male who steals a bicycle as a gang initiation A 9-year-old male who smokes half a pack of cigarettes a day A 12-year-old female who regularly bullies her younger siblings A 9-year-old female who engages in sexually provocative behaviors

A 12-year-old male who steals a bicycle as a gang initiation -In adolescent-onset conduct disorder, no symptoms are present prior to age 10. Affected adolescents tend to act out misconduct with their peer group (e.g., early onset of sexual behavior, substance abuse, risk-taking behaviors). Males are more likely to fight, steal, vandalize, and have school discipline problems, whereas girls tend to lie, be truant, run away, abuse substances, and engage in prostitution

Which behavior consistently demonstrated by a child is a predictor of future antisocial personality disorder in adults? Sadness Remorse Guilt Callousness

Callousness

Adolescents often display fluctuations in mood along with undeveloped emotional regulation and poor tolerance for frustration. Emotional and behavioral control usually increases over the course of adolescence due to: Limited executive function Cerebellum maturation Cerebral stasis and hormonal changes A slight reduction in brain volume

Cerebellum maturation

When discussing Oppositional Defiant Disorder with a group of parents, what information should the nurse include about the disorder? (SATA) Classic symptoms include anger, irritation, and defiant behavior Children generally outgrow the behaviors without formal treatment Severity is considered mild when symptoms are present only in one setting Disorder is diagnosed equally in males and females Argumentative and defiant are terms often used to describe the patient

Classic symptoms include anger, irritation, and defiant behavior Children generally outgrow the behaviors without formal treatment Severity is considered mild when symptoms are present only in one setting Argumentative and defiant are terms often used to describe the patient

The nurse is preparing to set goals for a 10-year-old diagnosed with an impulse control disorder. To best ensure the expected therapeutic outcomes, the nurse includes goals that focus on what client need? Client centered and includes the client's input Age appropriate and achievable in a short period of time Simple and easily defined Family centered and long term in nature

Client centered and includes the client's input

Risper*idone*, Olanz*apine*, Queti*apine*, Zipras*idone*, and Aripiprazole are some of the meds used for: Oppositional Defiant Disorder Intermittent Explosive Disorder Conduct Disorder

Conduct Disorder *Atypical (2nd Gen) Antipsychotics*

The mother of a 6-year-old child expresses concern over the child's frequent temper outbursts. He deals with any frustration by bullying and hitting and seldom shows any remorse for his actions. The nurse who gathers this data will note that the child's behaviors are most consistent with which diagnosis? Social phobia Conduct disorder Oppositional defiant disorder Attention deficit hyperactivity disorder (ADHD)

Conduct disorder

Which disorder identifies with physical abuse of a parent and stealing?

Conduct disorder -abnormally aggressive behavior, lack of feelings/remorse

When a child demonstrates a temperament that prompts the mother to say, "She is just so different from me; I just can't seem to connect with her." The nurse should plan to provide which intervention? Suggest that the child's father become her primary caregiver. Encourage the mother to consider attending parenting classes. Counsel the mother regarding ways to better bond with her child. Educate the father regarding signs that the child is being physically abused.

Counsel the mother regarding ways to better bond with her child.

Some cultures have lower rates of dx conduct disorders than observed in Western societies. The lower rate of incidence may be contributed to: Strict parenting with corporal punishment Cultural expression of anger as normal behavior Parents' limited tolerance for externalizing behavior Widespread acceptance of conduct disorders

Cultural expression of anger as normal behavior

Tommy, a 12yo boy admitted to the pediatric psychiatric unit, has recently been diagnosed with conduct disorder. In the activity room, the games he wanted to play were already in use. He responded by threatening to throw the furniture and to hurt his peers who had the game he wanted. Nancy, a RN, recognizes that Tommy's therapy must include: Consistency in implementing the consequences of breaking the rules Empathetic reasoning when Tommy acts out in the activity room Teaching Tommy the benefits of socializing Solitary time so that Tommy can think about his actions

Consistency in implementing the consequences of breaking the rules

An adolescent in a resident program is planning for discharge. What type of contract is used with guidelines and rewards?

Behavioral Contract -this is a written/verbal agreement bw pt and nurse or other parties about behaviors, expectations, and needs. This is typically coupled w/ rewards positive and negative

Which social behavior is often a result of a child having been exposed to some form of abuse? Speech disorders Bullying others Eating disorders Delayed motor skills

Bullying others

A 17-year-old patient is admitted to the psychiatric unit after threatening his mother during an argument and is diagnosed with conduct disorder. Which of the following would be an appropriate short-term outcome for this patient? Engages in appropriate coping skills to manage stressors Expresses feelings Maintains self-control during hospitalization Mother will improve communication skills to interact with Eli.

Expresses feelings

What are the foundational concerns regarding the use of restraint and seclusion when providing care to children? Select all that apply. Parents may initiate a lawsuit if injury occurs. Staff have conflicted feelings leading to ineffectiveness. Research suggests both are psychologically and physically harmful. Staff tends to be undertrained in use of restraints in children. The principle of least restrictive intervention is a primary concern.

Research suggests both are psychologically and physically harmful. The principle of least restrictive intervention is a primary concern.

Parent-child interaction therapy is a treatment that assist families by identifying strategies that improve parenting and provide positive reinforcement for improving behaviors. How do they do this type of therapy?

Therapists (APRNs) sit behind a one-way mirror and coach parents through an ear audio device while they interact with their children. This reinforces positive behavior in the child. The goal is to improve parenting strategies and reduce problematic behavior.

Which statement is true about the characteristics of the oppositional defiant child? The defiance is generally directed toward parents and siblings. These behaviors are a predictor of future mental health disorders. Arguing tends to be more prevalent in boys. Girls display more blaming than do boys.

These behaviors are a predictor of future mental health disorders.

A 10-year-old who is frequently disruptive in the classroom begins to fidget and then moves on to disruptive behavior. What is the most appropriate initial technique for managing this sort of disruptive behavior? Therapeutic holding Seclusion Quiet room Touch control

Touch control

What movements are associated with Autism Spectrum Disorder?

Twirling / twisting while walking, repetitive movements, rocking back and forth, jaw clenching

A 9-year-old patient has been diagnosed with an intellectual development disorder (IDD). Which assessment findings support this diagnosis? Select all that apply. Unable to explain the phrase, "Raining cats and dogs" Reads below age level Is capable of providing effective oral self care Enjoy interacting with developmentally similar peers Physically lashes out when frustrated

Unable to explain the phrase, "Raining cats and dogs" Reads below age level Physically lashes out when frustrated --IDD = mental retardation

When parents share that their 8-year-old child seems to "always try to be annoying and hateful," the nurse suspects the child is demonstrating which characteristic? Emotionally immature Anxiety Vindictiveness Depression

Vindictiveness

Methyphenidate is for

ADHD -SE: insomnia, wt loss, growth/developmental issues, headache, abdominal pain, lethargy, urinary retention

Amphetamine salts is used for

ADHD -also Methyphenidate

What diagnosis are central nervous system stimulants ordered for?

ADHD --Methyphenidate

A technique used after an undesirable or inappropriate behavior to engage or re-engage an individual in an appropriate activity. It may involve the use of verbal directives such as setting firm limits, gestures, or physical prompts.

Redirection

fidgets, runs and climbs excessively, talks excessively

hyperactivity

The family of a child diagnosed with attention deficit hyperactivity disorder (ADHD), inattentive type, is told the evaluation of their child's care will focus on symptom patterns and severity. What is the focus of child's evaluation? Select all that apply. Academic performance Activities of daily living Physical growth Social relationships Personal perception

Academic performance Activities of daily living Social relationships Personal perception

A person lost their job and they have a few interviews lined up for a new job. All of the sudden, they won't go to the store or their interviews. They just lay on their couch and yell at their kids all day. What disorder does this describe?

Adjustment Disorder -Person is having a hard time adjusting to change

A 12-year-old male patient diagnosed with Tourette's disorder is visiting his provider. The nurse will prepare medication teaching on which class of medication to help manage the tics associated with this disorder? Select all that apply. Mood stabilizers Antianxiety agents Anticholinesterase inhibitors First-generation antipsychotics Second-generation antipsychotics

Antianxiety agents (clonazepam ) First-generation antipsychotics (haloperidol and pimozide) Second-generation antipsychotics (aripiprazole)

Which of the following classifications of medication may be prescribed in intermittent explosive disorder? Anticonvulsants Psychostimulants Antianxiety agents such as benzodiazepines Monoamine oxidase (MAO) inhibitors

Anticonvulsants --And: mood stabilizers (lithium); 1st gen for calming effect; beta blockers to slow HR; SSRIs (fluoxetine)

As an adult, a client who has been diagnosed with childhood-onset conduct disorder is at high risk for developing which comorbid disorder? Antipersonality disorder Obsessive-compulsive disorder Kleptomania Depression

Antipersonality disorder

Assessment for oppositional defiant disorder should include which interventions? Assessing the history, frequency, and triggers for violent outbursts Assessing moral development, belief system, and spirituality for the ability to understand the impact of hurtful behavior on others, to empathize with others, and to feel remorse Assessing issues that result in power struggles and triggers for outbursts Assessing sibling birth order to understand the dynamics of family interaction

Assessing issues that result in power struggles and triggers for outbursts -Oppositional defiant disorder is characterized by defiant behavior, power struggles, outbursts, and arguing with adults, so assessment of these factors would be important

A 7-year-old, who is described as impulsive and hyperactive, tells the nurse, "I am a dummy, because I don't pay attention, and I can't read like the other kids." The nurse notes that these behaviors are most consistent with which diagnosis? Attention deficit disorder Attention deficit hyperactivity disorder Autism Conduct disorder

Attention deficit hyperactivity disorder

Which comorbid conditions are commonly associated with oppositional defiant disorder? Select all that apply. Conversion disorder Attention deficit hyperactivity disorder (ADHD) Depression Anxiety Substance abuse

Attention deficit hyperactivity disorder (ADHD) Depression Anxiety Substance abuse

A 3 year old that is mute, passive toward adults and twirls while walking would indicate which neurodevelopmental disorder?

Autism Spectrum Disorder

What familial tract is identified as the highest risk for a child to develop a psychiatric disorder?

Drug and Alcohol Use

Larry, a middle-aged male in treatment is loudly displaying anger in the day room with a visiting family member. It is obvious to the nurse that this pattern has played out before. Violence is often escalated when family members or authority figures: Use soft tone of voice to gain control of the situation Move away from the agitated person in fear Use simple words to communicate Engage in a power struggle

Engage in a power struggle

Which nursing intervention is appropriate for the management of intermittent explosive disorder? Providing intensive family therapy Establishing a trusting relationship with the patient Setting up loose boundaries so the patient will feel relaxed Limiting decision-making opportunities to avoid frustration

Establishing a trusting relationship with the patient

What assessment data would support a diagnosis of conduct disorder? (SATA) Evidence of social isolation Arrested twice for disorderly conduct Expresses difficulty in keeping employment Demonstrates objective signs of phobia Exhibits signs of chronic self-mutilation

Evidence of social isolation Arrested twice for disorderly conduct Expresses difficulty in keeping employment

A client diagnosed with conduct disorder craves what experience? Excitement without concern for possible negative outcomes Control of situations and constantly strategizes for such power Friendship but from those older than themselves Material possessions but lacks focus and direction

Excitement without concern for possible negative outcomes -People with conduct disorder crave excitement and do not worry as much about consequences as other people do

Which behavior is most indicative of a 4-year-old child diagnosed with Tourette's syndrome? Difficulty in social relationships Humming while performing activities that require concentration Frequent eye blinking Difficulty in completing tasks on time

Frequent eye blinking

What medication most likely causes dystonia and other EPS? Risperidone Haloperidol Aripiprazole Quetiapine

Haloperidol -1st gen (typical) -positive s/s: hallucinations ---The rest of the meds listed are atypical (2nd gen)

When treating impulse control disorders, psychodynamic psychotherapy is directed toward which goal? Mastering relaxation techniques Identifying the triggers of the rage Teaching the client self-distracting techniques Helping the client replace the rage with acceptable alternative feelings

Identifying the triggers of the rage

Nursing diagnosis that is universally applied for children dx with autism spectrum disorders?

Impaired social interaction r/t difficulty relating to others

A child that is unable to take turns, blurts out answers to questions before questions are complete and frequently interrupts conversations would be documented as having what behavior?

Impulsiveness (ADHD) (know difference between: inattention, hyperactivity, and impulsiveness)

Bullying and animal cruelty with remorse identifies with what diagnosis?

Intermittent Explosive Disorder

Which of the following statements are true regarding childhood-onset conduct disorder? Select all that apply. It is more commonly diagnosed in males. It is characterized by feelings of remorse and regret. It is usually diagnosed in late teen years. It is characterized by disregard for the rights of others. Those with conduct disorder rationalize their aggressive behaviors. It is usually outgrown by early adulthood.

It is more commonly diagnosed in males. It is characterized by disregard for the rights of others. Those with conduct disorder rationalize their aggressive behaviors.

When working with a client demonstrating impulse control disorders, which nursing interventions have initial priority? Select all that apply. Providing a safe environment Establishing a therapeutic nurse-client relationship Setting and enforcing limits Confronting the client concerning the disruptive behavior Presenting appropriate expectations

Providing a safe environment Establishing a therapeutic nurse-client relationship Setting and enforcing limits Presenting appropriate expectations

Which factors tend to increase the difficulty of diagnosing young children who demonstrate behaviors associated with mental illness? (SATA) Limited language skills Level of cognitive development Level of emotional development Parental denial that a problem exists Severity of the typical mental illnesses observed in young children

Limited language skills Level of cognitive development Level of emotional development

An 8-year-old patient is newly diagnosed with attention deficit hyperactivity disorder (ADHD). It is important that the parents be educated to the fact that symptoms will take which form of, inattention, and impulsivity have to be apparent: Select all that apply. Low frustration tolerance Poor school performance Impulsive behaviors Easily intimidated Mood swings

Low frustration tolerance Poor school performance Impulsive behaviors Mood swings

The impulse control spectrum can begin in childhood and continue on into adulthood, often morphing into criminal behaviors. Working with patients diagnosed with these disorders, the best examples of expressed emotion by the nursing staff are: Low to prevent emotional reactions Matched to the patient's level of emotion Flat without evidence of any emotional output High expression to improve therapeutic patient emotions

Low to prevent emotional reactions

-Greiving is Prolonged -Clinical manifestations severe

Maladaptive Dysfunctional Grieving?

Most extensive type of therapy. Intensive family and community based program that takes into consideration all of the environment of violent juvenile offenders: Psychodynamic Psychotherapy Dialectical Behavioral Therapy Parent Management Training Multisystemic Therapy

Multisystemic Therapy

What disorder is associated with vindictive behaviors?

Oppositional defiant disorder

A person has experienced war related trauma is showing negative symptoms by isolating themselves, not engaging, avoidance, and depression. What is this person experiencing?

PTSD

You're teaching a consumer relaxation techniques. Which part of the nervous system do you want to target?

Parasympathetic -Sympathetic: fight/flight -Parasympathetic: slows down/calming

A nurse assesses a patient diagnosed with Dissociative Identity Disorder. Which finding would likely be part of the patient's history? Travel to a foreign country Physical or sexual abuse Thyroid dysfunction Eating Disorder

Physical or sexual abuse

Which event experienced in the patient's childhood increases the risk of development of behaviors associated with intermittent explosive disorder? Orphaned at age 4 Physically abused from ages 3-10 Born with a chronic congenital disorder One parent was diagnosed with OCD

Physically abused from ages 3-10

Group therapy for a child 10 and under would include what type of activities?

Play, learning skills, talking about the activity

Which factor can reduce the vulnerability of a child to etiological influences predisposing to the development of psychopathology? Resilience Malnutrition Child abuse Having a depressed parent

Resilience -Resilience refers to developing and using certain characteristics that help a child to handle the stresses of a difficult childhood without developing mental problems. Resilient children can adapt to changes in the environment, form nurturing relationships with adults other than their parents, distance themselves from the emotional chaos of the family, and have social intelligence and the ability to use problem-solving skill

most popular group of meds to treat mood and reduce anxiety in autism?

SSRIs

What is a common behavior observed in a patient diagnosed with intermittent explosive behavior? (SATA) Short attention span Threatens suicide Often purges after eating Uses alcohol to excess States, "Everyone is out to get me"

Short attention span Threatens suicide Uses alcohol to excess

A 5-year-old who consistently omits the sound for 'r' and 's' when speaking is demonstrating which type of disorder? Speech Language Social communication Specific learning

Speech

Pyromania, a behavior associated with impulse control disorders, causes an individual to engage in what behavior? Starting fires Stealing for thrill Self-mutilate Directing anger toward others

Starting fires

What comorbidity is the same for Oppositional Defiant Disorder, Intermittent Explosive Disorder, Conduct Disorder?

Substance Abuse

A child with ADHD slaps another child, what nursing action do you take? Instruct the parents to take the aggressive child home Direct the aggressive child to stop immediately Call for emergency assistance from other staff Take the aggressive child to another room

Take the aggressive child to another room

When a nurse assesses the style of behavior a child habitually uses to cope with the demands and expectations of the environment, he or she is assessing characteristic? Temperament Resilience Vulnerability Cultural assimilation

Temperament -Temperament is the behavior the child habitually uses to cope with the environment. It is a constitutional factor thought to be genetically determined. It may be modified by the parent-child relationship.

A nurse on an adolescent psychiatric unit assesses a newly admitted 14-year-old. An impulse control disorder is suspected. Which aspects of the patients history support the suspected diagnosis? Select all that apply. a. Family history of mental illness b. Allergies to multiple antibiotics c. Long history of severe facial acne d. Father with history of alcohol abuse e. History of an abusive relationship with one parent

a. Family history of mental illness d. Father with history of alcohol abuse e. History of an abusive relationship with one parent

Oppositional defiant disorder diagnosis is made when they exhibit what type of behaviors?

angry/irritable mood, argumentative / defiant behavior, and vindictiveness

What are the primary distinguishing factors between the behavior of persons diagnosed with oppositional defiant disorder (ODD) and those with conduct disorder (CD)? Select all that apply. The person diagnosed with: a. ODD relives traumatic events by acting them out. b. ODD tests limits and disobeys authority figures. c. ODD has difficulty separating from loved ones. d. CD uses stereotypical or repetitive language. e. CD often violates the rights of others.

b. ODD tests limits and disobeys authority figures. e. CD often violates the rights of others. -Persons diagnosed with ODD are negativistic, disobedient, and defiant toward authority figures without seriously violating the basic rights of others, whereas persons with conduct disorder frequently behave in ways that do violate the rights of others and age-appropriate societal norms. Reliving traumatic events occurs with posttraumatic stress disorder. Stereotypical language behaviors are seen in persons with autism spectrum disorders.

A nurse works with an adolescent who was placed in a residential program after multiple episodes of violence at school. Establishing rapport with this adolescent is a priority because: (select all that apply) a. it is a vital component of implementing a behavior modification program. b. a therapeutic alliance is the first step in a nurses therapeutic use of self. c. the adolescent has demonstrated resistance to other authority figures. d. acceptance and trust convey feelings of security for the adolescent. e. adolescents usually relate better to authority figures than peers.

b. a therapeutic alliance is the first step in a nurses therapeutic use of self. d. acceptance and trust convey feelings of security for the adolescent.

How do you know if treatment is effective with autism?

child begins to positively interact with parent

Assessing for the ability to understand the impact of hurtful behaviors on others refers to assessment for

conduct disorder.

Anosognosia

inability to realize you are ill

difficulty paying attention to task at hand, easily distracted

inattention --ADHD

What desired behavior would be noted for a child with ADHD on amphetamine salts who is exhibiting hyperactivity, aggression and impaired play?

increased attention, task-directed behavior, ↓ impulsiveness/restlessness/distractability

Assessing for violent outbursts refers to assessment for

intermittent explosive disorder

What medication is used to treat oppositional defiant disorder?

none

The focus of this therapy is on the parent, not the child. Teaches reinforcement of positive/prosocial behavior, and on brief, negative consequences of bad behavior. Promotes *nurturing home with consistent limits and boundaries*: Parent-child Interaction Therapy Dialectical Behavioral Therapy Parent Management Training Multisystemic Therapy

parent management training

Suicide risk is high when the individual has a lethal

plan

A child diagnosed with autism will demonstrate impaired development in which area? Adhering to routines playing with other children swallowing and chewing eye-hand coordination

playing with other children

Adaptability to change in environment, ability to form nurturing relationships with other adults when parent isn't available:

resiliency

Which nursing diagnosis should be considered for a child with attention deficit hyperactivity disorder ADHD? Anxiety risk for injury defensive coping impaired verbal communication

risk for injury

the behavior the child habitually uses to cope with the environment.

temperament

Which activity is most appropriate for a child with ADHD? Reading an adventure novel Monopoly Checkers Tennis

tennis

Less restrictive alternative to seclusion and restrains

time out

A poorly developed sense of empathy is thought to be the result of having what life experience? A family history of mental illness a low serum testosterone level suffered head trauma at an early age unmet physical and emotional needs

unmet physical and emotional needs