Psychiatric Disorders Usually Associated with Childhood and Adolescence (EXAM 2)

*Assessment Considerations-similar to adult assessment except: PT1* -Explain the assessment process ________, elicit/address any concerns the child may have -Consider which info should/must be shared with _______. -Technique varies with _____________. -Adapt communication to child's _______. -Developing trust may require _________ than for adults, adolescents esp. may be resistant, mistrust adults -Use ______ phrases, examples to clarify what you are asking (make it more concrete) -Use more _______ questions, fewer ________ questions for younger children

*Assessment Considerations-similar to adult assessment except: PT1* -Explain the assessment process _______, elicit/address any concerns the child may have -Consider which info should/must be shared with _______. -Technique varies with ________ stage. -Adapt communication to child's ________. -Developing trust may require _________ than for adults, adolescents esp. may be resistant, mistrust adults -Use ______ phrases, examples to clarify what you are asking (make it more concrete) -Use more _______ questions, fewer ________ questions for younger children

*Assessment Considerations-similar to adult assessment except: PT2* -May use _______: (toys, art, etc), drawing, role plays (playing house, school), games (school age) -Interview child in what 2 scenarios? -Children usually provide better info about _______ symptoms (3?) than parents -Parents often provide better information about ________ symptoms (2?) -Assess: 11?

*Assessment Considerations-similar to adult assessment except: PT2* -May use *play media* (toys, art, etc), drawing, role plays (playing house, school), games (school age) -Interview child and parent *separately*, then *together* to assess interactions between child and parent -Children usually provide better info about *internal symptoms (mood, sleep, suicide ideation)* than parents -Parents often provide better information about *externalizing symptoms (behavior, relationships)* -Assess: *Psychosocial development, language, self-concept, attachment, temperament, fine and gross motor skills, stressors, coping responses, school performance, behavior, and family functioning*

*Assessment Considerations-similar to adult assessment except: PT3* -Younger children more likely to alter responses to ____________, __________(are not always reliable informants); __________ (confirm) information with adult where possible -Adolescents: tend to show what 3 possible behaviors?; let them know what information will be shared with ________ (use a _______ approach) -Allow parents to express ________ as needed (convey empathy) -Info from ___________ is also important -Diagnosis of childhood onset psychiatric disorders is usually based on what 2 things? >>however, some biological tests are being studied, e.g. certain ________ may be diminished in autism and these can be measured

*Assessment Considerations-similar to adult assessment except: PT3* -Younger children more likely to alter responses to *please the interviewer*, *protect family* (are not always reliable informants); *need to validate* (confirm) information with adult where possible -Adolescents: tend to be *egocentric, self-consciousness, fear being shamed*; let them know what information will be shared with *parents*; *(use a direct, candid approach)* -Allow parents to express *frustration* as needed (convey empathy) -Info from *day care, school* is also important -Diagnosis of childhood onset psychiatric disorders is usually based on *behavior and history*; however, some biological tests are being studied, e.g. certain *salivary proteins* may be diminished in autism and these can be measured

*Attention Deficit Hyperactivity Disorder* -Affects ___-___% of school-aged children, misdiagnosis or missed diagnosis are common. -what gender more common in? -children living in _______ diagnosed more often -____-____% continue to have problems with attention and impulsiveness into adulthood (but most go untreated in adulthood)

*Attention Deficit Hyperactivity Disorder* -Affects *6-10%* of school-aged children, misdiagnosis or missed diagnosis are common. -*Boys* more affected than girls *(2-3x more)* -children living in *poverty* diagnosed more often -*30-40%* continue to have problems with attention and impulsiveness into adulthood (but most go untreated in adulthood)

*Child-Adolescent Mental Illness* -____ to ___ million children and adolescents in the US have serious emotional disturbances -Suicide is the ___ leading cause of death among adolescents -Approximately ____% of children & adolescents who need mental health services do not get them -___% of children between the ages of 9-17 have serious emotional disturbance with extreme functional impairment -Only ____% are receiving appropriate treatment -____-___% of families who begin treatment terminate treatment prematurely

*Child-Adolescent Mental Illness* -*6 to 9 million* children and adolescents in the US have serious emotional disturbances -Suicide is the *3rd* leading cause of death among adolescents -Approximately *70%* of children & adolescents who need mental health services do not get them -*10%* of children between the ages of 9-17 have serious emotional disturbance with extreme functional impairment -Only *20%* are receiving appropriate treatment -*40-60%* of families who begin treatment terminate treatment prematurely

*Developmental Disorders: Intellectual Disability (ID)* -Diagnosed through clinical assessment of what 3 things? -Asses and compare with usual growth and development of what 3 things?

*Developmental Disorders: Intellectual Disability (ID)* -Diagnosed through clinical assessment of *behaviors, history, and performance on standardized tests* -Assess and compare with usual growth and development : *Current adaptive skills, Intellectual status, Social functioning*

It is important to not assume what when seeing both Disruptive Behavior Disorders? instead do what?

*Do not assume parenting skills are poor in children with these disorders* as they can occur even when parenting is sound. -Instead, approach parents from the perspective that special or additional skills (above and beyond what most parents might typically have) may be needed until the child's behavior improves.

How can we disrupt high risk repetitive behavior? and what do we do when this high risk behavior is persistent?

*Engaging in simple, concrete distracting activities may interrupt self-destructive behavior, and substituting behaviors that are safer can also be beneficial* (e.g. shift person to rocking instead of head-banging). -*For persistent self-injurious behavior, close monitoring and protective equipment* (e.g thick mittens to prevent biting fingers or gouging of face or eyes) may be essential.

*For the exam you do not need to know the actual IQ range for each level of intellectual disability (ID, formerly mental retardation).* Significantly below-average intelligence accompanied by impaired adaptive functioning -Mild IQ ~ 50-70 -Moderate IQ ~ 50-70 -Severe IQ ~ 20-30 -Profound IQ below 20

*For the exam you do not need to know the actual IQ range for each level of intellectual disability (ID, formerly mental retardation).* Significantly below-average intelligence accompanied by impaired adaptive functioning -Mild IQ ~ 50-70 -Moderate IQ ~ 50-70 -Severe IQ ~ 20-30 -Profound IQ below 20

*What is triangulation?*

*IS WHEN TWO MEMBERS OF A TRIAD ALIGN AGAINST THE REMAINING ONE, E.G. DAD AND MOM ALIGN AGAINST CHILD (E.G. BLAMING CHILD FOR THEIR DISTRESS)*

*Major Depressive Disorder* 1 to 5% in what age group? (______age group is higher)

*Major Depressive Disorder* 1 to 5% of school-aged children (adolescents higher)

Nursing Diagnoses- Psychiatric Disorders Associated with Childhood or Adolescence (12)

*Nursing Diagnoses- 12* -Ineffective coping; defensive coping -Delayed growth and development -Interrupted family processes; compromised family coping -Impaired social interaction -Impaired verbal communication -Social isolation -Self-care deficit -Risk for imbalanced nutrition -Risk for injury (self-directed, other-directed -Disturbed sleep pattern -Anxiety -Ineffective role performance (You do not need to memorize nsg diagnoses, these are just FYI should you need them later in your career.)

*Nursing Interventions for Developmental Disorders: Intellectual Disability (ID)* -Environment? -Routine? -_______ and/or structured activity programming and support is helpful -Teach & promote.... -_______ education (nutrition, sexuality, self-care) -_____ education & support

*Nursing Interventions for Developmental Disorders: Intellectual Disability (ID)* -Create safe environment (hazard reduction, stimulation management) -Predictable, structured routine—minimize changes -Vocational and/or structured activity programming and support is helpful -Teach & promote coping, social, life skills (e.g. ADL) -Health education (nutrition, sexuality, self-care -Parent education & support

*OVERVIEW OF Separation and Divorce* -Children are at increased risk for emotional, behavioral, & academic problems, esp. for first 2-3 years post divorce -Impact on child varies with child's age, how parents handle the divorce (e.g. triangulation*, recrimination, custody struggles), available supports, coping ability, presence of other stressors -May experience impaired ability to trust others, establish & maintain relationships in later life -May act out, causing disciplinary, drug/alcohol problems -Stepfamilies develop, can lead to other problems -What helps: educate parents about children's needs, support regular & predictable visitations, reduce conflict between parents, maintain usual routines, family counseling & support

*OVERVIEW OF Separation and Divorce* -Children are at increased risk for emotional, behavioral, & academic problems, esp. for first 2-3 years post divorce -Impact on child varies with child's age, how parents handle the divorce (e.g. triangulation*, recrimination, custody struggles), available supports, coping ability, presence of other stressors -May experience impaired ability to trust others, establish & maintain relationships in later life -May act out, causing disciplinary, drug/alcohol problems -Stepfamilies develop, can lead to other problems -What helps: educate parents about children's needs, support regular & predictable visitations, reduce conflict between parents, maintain usual routines, family counseling & support

*OVERVIEW of attachment theory* -Infants have an innate need to bond, tend to bond to one primary parental figure, usually the mother -Fathers' emotional support tends to enhance the quality of mother-child relationships and aids in positive adjustment by children -Mother-child attachment is associated with perceived self-worth and physical appearance -Child-father attachment is associated with child-perceived school competence

*OVERVIEW of attachment theory* -Infants have an innate need to bond, tend to bond to one primary parental figure, usually the mother -Fathers' emotional support tends to enhance the quality of mother-child relationships and aids in positive adjustment by children -Mother-child attachment is associated with perceived self-worth and physical appearance -Child-father attachment is associated with child-perceived school competence

*PDD: Asperger's Disorder-OVERVIEW* -Incorporated into Autism Spectrum Disorders in DSM 5 -1-3/10,000 people -More common in boys -Runs in families -Normal or above normal intelligence, good verbal skills -Similar to autistic disorder but typically no clinically significant delays in language acquisition or cognitive development -Physical clumsiness, overactivity, stereotypical behaviors may be present -Inattention can be a concern -Mild to profound social deficits

*PDD: Asperger's Disorder-OVERVIEW* -Incorporated into Autism Spectrum Disorders in DSM 5 -1-3/10,000 people -More common in boys -Runs in families -Normal or above normal intelligence, good verbal skills -Similar to autistic disorder but typically no clinically significant delays in language acquisition or cognitive development -Physical clumsiness, overactivity, stereotypical behaviors may be present -Inattention can be a concern -Mild to profound social deficits

*Parent education & support* -Support _____ and ______ -Teach & support ______ management skills -Education about.... -Sound _________ between school, parents -Caregiver_______, prevent caregiver fatigue

*Parent education & support* -Support self care and coping efforts -Teach & support behavior management skills -Education about disorder, implications -Sound communication between school, parents -Caregiver respite, prevent caregiver fatigue

*Pervasive Developmental Disorders (PDD) Assessment: * -Physical health & neurologic status; co-morbid disorders (Ex: ____ dis in autism, _____in Asperger's) -____ & _____ patterns -what abilities? -look at what skills? -Capacity for..... -Current..... -Hx, risk re: (3) -Impact of....

*Pervasive Developmental Disorders (PDD) Assessment: * -Physical health & neurologic status; co-morbid disorders (*seizure* dis in autism, *depression* in Asperger's) -*Eating and sleep* patterns -*Intellectual* abilities -*Communication, social, life* skills -Capacity for *self-care, efforts at adaptive functioning, outcomes* (are they working?) -Current *medications, other treatments* (& effectiveness) -Hx, risk re: *self-injury, aggression, other safety issues* (e.g. ability to move about community safely) -Impact of *developmental issues, needs on family*

*Pharmacologic Interventions in PDD* -______________: severe behavioral disruption, psychosis -_______________ et al: inattention, impulsivity, and overactivity; consider regular vs. long-acting forms -_______________ for excessive activity level and inattention -_______________: helps reduce hyperactivity, excess self-stimulation, and irritability -__________ and _________: mild sedation, reduce agitation -_____________ may increase social functioning in 3-8 year olds

*Pharmacologic Interventions in PDD* -*Antipsychotics:* severe behavioral disruption, psychosis -*Methylphenidate (Ritalin)* et al: inattention, impulsivity, and overactivity; consider regular vs. long-acting forms -*Opioid antagonist naltrexone* for excessive activity level and inattention -*Clonidine:* helps reduce hyperactivity, excess self-stimulation, and irritability -*Buspirone and trazodone:* mild sedation, reduce agitation -*Intranasal oxytocin* may increase social functioning in 3-8 year olds

MATCH Death and Grieving BELOW: -Preschool-aged -School-aged -Adolescents -Unable to express feelings in a grownup way -Express grief through somatic complaints, regression, behavior problems, withdrawal, anger/hostility, reduced school performance -Understand death as an abstract concept -May have a romantic idea of death *(increases suicide risk)* -If parent has died (or is ill), may assume parental role -May react more to others' responses than to the death itself -Need reassurance -Helps if adults avoid euphemisms (e.g., "he went to sleep")

*Preschool-aged* -May react more to others' responses than to the death itself -Need reassurance -Helps if adults avoid euphemisms (e.g., "he went to sleep") *School-aged* -Unable to express feelings in a grownup way -Express grief through somatic complaints, regression, behavior problems, withdrawal, anger/hostility, reduced school performance *Adolescents* -Understand death as an abstract concept -May have a romantic idea of death *(increases suicide risk)* -If parent has died (or is ill), may assume parental role

*Risk Factors for Psychopathology OVERVIEW* *ADVERSE CHILDHOOD EVENTS, including:* -Poverty, homelessness—also increase risk for physical health problems, stigma, isolation, and educational underachievement, all perpetuating cycle of poverty -Child abuse and neglect -Out-of-home placement -Negative subcultures that endorse/model crime, drug abuse, etc -Substance abuse in parents, and/or in child him/herself -Mental illness in parents (Child's responses may include: Negative emotional responses and maladaptive coping may include detachment, rage, depression, antisocial behavior, low self-esteem, chronic dependency, poor school performance, self-injurious behavior, substance abuse, acting out, suicidality)

*Risk Factors for Psychopathology OVERVIEW* *ADVERSE CHILDHOOD EVENTS, including:* -Poverty, homelessness—also increase risk for physical health problems, stigma, isolation, and educational underachievement, all perpetuating cycle of poverty -Child abuse and neglect -Out-of-home placement -Negative subcultures that endorse/model crime, drug abuse, etc -Substance abuse in parents, and/or in child him/herself -Mental illness in parents (Child's responses may include: Negative emotional responses and maladaptive coping may include detachment, rage, depression, antisocial behavior, low self-esteem, chronic dependency, poor school performance, self-injurious behavior, substance abuse, acting out, suicidality)

*OVERVIEW: STIMULANTS* *Ritalin (methylphenidate)* -Available in regular, sustained release (educate pt not to chew), and long acting (Concerta) forms -Regular form lasts 3-4 hours so is needed more often, can be disruptive in school (peers notice, tease or bully pt) -Regular form is usually bid or tid dosing, dosage varies with individual, typically 10-60mg/day -Side effects include nervousness, dizziness, insomnia, headache, tics or dyskinesias, GI distress (pain, nausea), decreased appetite, increased pulse or BP, weight loss, restlessness, agitation -Ritalin's potentially dangerous SE's: palpitations, SOB, seizures, psychosis; risk of sudden death if pt has cardiac disease *Adderall (dextroamphetamine and amphetamine)* -Regular form is taken bid or tid; extended release form is taken QD before school (less disruptive) -Similar abuse risk to Ritalin and other stimulants -Side effects similar to Ritalin plus tremor, constipation *Vyvanse (lisdexamfetamine dimesylate [LDX])* -inhibits reuptake of DA and NE and elicits the release of monoamine neurotransmitters -is a pro-drug: is itself inactive until it is metabolized to amphetamine -Result is less abuse potential (d/t delayed effects) and longer duration of action -Side effects similar to other amphetamine products

*Ritalin (methylphenidate)* -Available in regular, sustained release (educate pt not to chew), and long acting (Concerta) forms -Regular form lasts 3-4 hours so is needed more often, can be disruptive in school (peers notice, tease or bully pt) -Regular form is usually bid or tid dosing, dosage varies with individual, typically 10-60mg/day -Side effects include nervousness, dizziness, insomnia, headache, tics or dyskinesias, GI distress (pain, nausea), decreased appetite, increased pulse or BP, weight loss, restlessness, agitation -Ritalin's potentially dangerous SE's: palpitations, SOB, seizures, psychosis; risk of sudden death if pt has cardiac disease *Adderall (dextroamphetamine and amphetamine)* -Regular form is taken bid or tid; extended release form is taken QD before school (less disruptive) -Similar abuse risk to Ritalin and other stimulants -Side effects similar to Ritalin plus tremor, constipation *Vyvanse (lisdexamfetamine dimesylate [LDX])* -inhibits reuptake of DA and NE and elicits the release of monoamine neurotransmitters -is a pro-drug: is itself inactive until it is metabolized to amphetamine -Result is less abuse potential (d/t delayed effects) and longer duration of action -Side effects similar to other amphetamine products

*SIDE NOTE: Pervasive Developmental Disorders (PDD)* The previous thinking (DSM IV-TR and earlier) was that these were separate disorders. The DSM5 conceptualizes them as related disorders that are on a continuum, with varying degrees of symptomatology (this is a somewhat controversial issue for some of those with these disorders, their families, and advocates).

*SIDE NOTE: Pervasive Developmental Disorders (PDD)* The previous thinking (DSM IV-TR and earlier) was that these were separate disorders. The DSM5 conceptualizes them as related disorders that are on a continuum, with varying degrees of symptomatology (this is a somewhat controversial issue for some of those with these disorders, their families, and advocates).

What are the MEDS used for ADHD?

*Stimulants are the primary pharmacological treatment*

*WHAT IS THE NON STIMULANT BELOW USED FOR ADHD* -Is a selective norepinephrine reuptake inhibitor, not a stimulant -Little risk of abuse; *possible increase suicide risk!!!* -Side effects: HA, GI distress, decreased appetite, fatigue, irritability, decreased appetite, somnolence, *allergic rx's!!!*

*Strattera (Atomoxetine)* -Is a selective norepinephrine reuptake inhibitor, not a stimulant -Little risk of abuse; *possible increase suicide risk!!!* -Side effects: HA, GI distress, decreased appetite, fatigue, irritability, decreased appetite, somnolence, *allergic rx's!!!*

*SIDE NOTE ABOUT WHOLE LECTURE /SPECIFICALLY AUTISM* what book does Ed recommend for those with, or who care about, autism??

*The Reason I Jump (book):* it helps one understand the seemingly illogical behavior, to appreciate that they often serve a purpose (and are logical to the pt), and can reduce a) conflict (between pt and others), b) the pt's guilt about those behaviors, and c) shame (of both family and pt). This book should be required reading for all teachers and other professionals working with children with autism spectrum disorders, and there are other, similarly helpful first-person accounts of these disorders that are very enlightening.

*The hopes of children* -My dream is to help the elders in my family. Shahaad, 9 -My dream is to help other homeless people. Britney, 12 -My hope is to never come back to the shelter. Jashon, 10 -My dream is to have a dog. Jania, 11 -My dream is for my family to be safe. Demario, 9

*The hopes of children* -My dream is to help the elders in my family. Shahaad, 9 -My dream is to help other homeless people. Britney, 12 -My hope is to never come back to the shelter. Jashon, 10 -My dream is to have a dog. Jania, 11 -My dream is for my family to be safe. Demario, 9

Children for first 2-3 years post divorce & separation are at a increase risk for?

*risk for emotional, behavioral, & academic problems* (esp. for first 2-3 years post divorce)

Another risk factor is _____________________________________. Although most children growing up in such households do not experience significant psychopathology, statistically such children are at increased risk of anxiety and mood disorders, substance abuse, performing below their potential educationally and vocationally, and being arrested.

*single parent household* (Note, however, that many single-parent households also involve poverty, so poverty may also be contributing to these outcomes.)

As a general rule, health info about children cannot be withheld from parents, but there are exceptions for older children? (2 examples)

-(e.g. info about sexual health or treatments) or -special circumstances (e.g. if sharing the info could result in increased risk of a parent harming the child).

*Prevention and Treatment Approaches* -_____________ is key: Keep the family as intact & functional as possible; allows maximal autonomy for child and family -_____________ programs for parents—parenting, social skills -______ skills training -__________ to promote coping, avert or mitigate maladaptive behavior (e.g. substance abuse) -______ therapy useful for younger children -_______ therapies—on-site therapists provide help in pt's environment in real time -_______ therapies: poetry, journals, art, music, etc -________ and other ______-involved therapies -________ support groups, ________ groups (e.g. conflict resolution for violence prevention)

-*Prevention is key*: Keep the family as intact & functional as possible; allows maximal autonomy for child and family -*Educational programs* for parents—parenting, social skills -Social skills training -*Family interventions* to promote coping, avert or mitigate maladaptive behavior (e.g. substance abuse) -*Play therapy* useful for younger children -*In-home* therapies—on-site therapists provide help in pt's environment in real time -*Expressive* therapies: poetry, journals, art, music, etc -*Equine* and other *animal*-involved therapies -*Peer* support groups, *educational* groups (e.g. conflict resolution for violence prevention)

*Physical Illness* -what 3 things will influence the family's ability to cope? -Chronic physical illness is linked to what 2 problems?

-*Resilience, coping skills, and how the family perceives an event* will influence the family's ability to cope -Chronic physical illness is linked to *emotional, behavioral problems*

Why does risk taking commonly occur in adolescents? -a sense of...... -lack of (2) -_______ pressure -limited _______ functions due to an........... (e.g. leading to poor judgment, impulsivity -inability to predict or appreciate......

-*a sense of invulnerability* ("although it's dangerous I won't get hurt") -*lack of knowledge or appreciation of the risk* ("drugs are OK as long as you don't do it regularly") -*peer pressure* -*limited cognitive functions due to an immature frontal lobe* (e.g. leading to poor judgment, impulsivity) -*inability to predict or appreciate consequences fully* , etc).

*Teach self-care skills -PDD's* -adapt teaching to what? -put what in bedroom? -what activity for nonverbal children?

-Adapted to child's skills and language limitations -List of activities posted in bedroom -Drawings for nonverbal children

*Interventions to help adolescents learn to not perform risk taking behaviors* -Adolescents tend to respond best to....... -Adolescents also tend to be motivated to respond to teaching or behavioral change when it comes from...... -Another effective approach to health education involves first person presentations, wherein..... (However, when it comes to changing behavior.....)

-Adolescents tend to respond best *to peers, so peer-based education and support can be more effective than that provided by adults. * -Adolescents also tend to be motivated to respond to teaching or behavioral change when it comes from *their peers.* -Another effective approach to health education involves first person presentations, wherein *a person who has actually had an experience shares what that was like (e.g. rather than a teacher preaching about the dangers of texting and driving, a fellow teen whose texting caused a horrible accident shares his story instead). * (However, when it comes to changing behavior, *no approach is full proof, and it is most important to adjust the approach used to match that particular audience. *)

*Separation Anxiety Disorder* -Affects ___% of school-aged children -May emerge after a ...

-Affects *4%* of school-aged children -May emerge after a *change*

*Stimulants* -All are potentially.... >>>>>>> -DUE TO: All enhancing the activity of what 2 neurotransmitters?

-All are potentially *abusable*; do not produce a high when used as prescribed for ADD/ADHD, but they can if snorted, injected, or used in high doses; DIVERSION IS A CONCERN. >>>>>>>>>>> -DUE TO: All enhance *dopamine and norepinephrine* activity

*Major Depressive Disorder* *Interventions similar to those for adults* -what med class? -what therapy? -_______ can be a greater concern than for adults. -Special attention needed r/t ....

-Antidepressants (care to maintain privacy) -Psychotherapy -*Stigma* can be a greater concern than for adults -Special attention needed r/t *motivation: difficulty initiating and completing tasks is common, affects school work* (consider flexible due dates, support)

What are 5 Mood and Anxiety Disorders?

-Anxiety disorders -Separation anxiety disorder -Obsessive-compulsive disorder -Major depressive disorder -Disruptive mood dysregulation disorder

*SIDE NOTE: PDD* -Concurrent psych disorders are not uncommon in this population, especially _________ AND _________. -Higher rates of neuro disorders such as various ___________ are also common.

-Concurrent psych disorders are not uncommon in this population, especially *schizophrenia and anxiety disorders (e.g. OCD).* -Higher rates of neuro disorders such as *various seizure disorders* are also common.

*Assessment -when considering ADHD* -__________ history -__________ history -look at what 3 patterns? -behavior? -behavior? -behavior? -_________ issues

-Developmental history -Medical history -Eating, sleeping, and activity patterns -Hyperactivity -Impulsivity -Inattention -Discipline issues

*Childhood Schizophrenia* -Diagnosis criteria? -Possibly exists even in i______ (e.g. hallucinations) -____ per 100,000 people(common?) -Poorer or better pre-morbid functioning than adult onset? -prognosis?

-Diagnosed by *same criteria as in adults* -Possibly exists even in *infancy* (e.g. hallucinations) -*Rare: 2* per 100,000 people -*Poorer pre-morbid functioning* than adult onset -Probably *poorer prognosis* (?)

*PDD: Autistic Spectrum Disorders* -onset? -gender more common? And gender more severe? -50% have ________(mild to profound); 25% have _______

-Early onset: before 30 months, 1 in 68 children -More boys than girls; girls=more severe, poorer outcomes -50% have intellectual impairment (mild to profound); 25% have seizure disorder

*What are the 7 Childhood Problems Contributing to Emotional Distress* hint: >>These are issues or situations that commonly cause emotional distress in children and that may be the focus of treatment. They may increase the risk of a child developing emotional distress or a psychiatric disorder, or can destabilize an existing disorder.

-Failure to bond -Family dysfunction—parents with emotional/psychiatric disorders, substance abuse, serious physical illness -Death and grieving -Separation and divorce -Sibling relationship issues -Physical illness -Adolescent risk-taking behaviors

What are the 3 types of Attention Deficit Hyperactivity Disorder?

-Hyperactive type—movement is main feature -Inattentive type—disorganization, decreased focus -Combined type

What are 3 clinical symptoms of PDD: Autistic?

-Impaired social communication -Fixated or restricted interests, activities; insist on sameness -Restricted, repetitive and stereotyped patterns of behavior

*Mild to profound social deficits in PDD: Asperger's Disorder* -Inappropriate initiation of..... -Difficulty recognizing, responding effectively to... -_______ or _______ in interpretation, use of language -________ in style, _______ of change -Sometimes exhibit behavioral _______ in response to changes in environment or routine -___________, relationships may be concerns

-Inappropriate initiation of *social interactions ("too trusting")* -Difficulty recognizing, responding effectively to social cues -*Eccentric or concrete* in interpretation, use of language -*Rigid* in style, *intolerant* of change -Sometimes exhibit *behavioral outbursts* in response to changes in environment or routine -*Sexuality*, relationships may be concerns

What is the attention span of PDD: Asperger's Disorder? and what is the social level?

-Inattention can be a concern -Mild to profound social deficits

*PDD: Asperger's Disorder* -Incorporated into ________ Disorders in DSM 5 -1-3/10,000 people -More common in what gender? -familial?

-Incorporated into *Autism Spectrum* Disorders in DSM 5 -1-3/10,000 people -More common in *boys* -Runs in *families*

*Disruptive Behavior: Nsg Interventions* -Increase ______________ for behavior -Decrease.... -Clarify ________ expectations—are they realistic, consistent? -________ management training -____________ r/t stress, conflict resolution, other needs prn -Medications: 3? are sometimes used (but are not the primary tx)

-Increase *personal responsibility* for behavior—*consequences* -Decrease *rule violations* -*Clarify parental expectations*—are they realistic, consistent? -*Parent management training*—parenting skills, G & D, etc -*Family therapy* r/t stress, conflict resolution, other needs prn -Medications: *Antipsychotics, anticonvulsants, mood stabilizers* are sometimes used (but are not the primary tx)

*What are the 4 treatments of separation anxiety disorder?* -Individual psychotherapy focusing on what 2 things? -Return to .... -Temporarily.... -what med class?

-Individual psychotherapy focusing on anxiety management and adjustment -Return to school as soon as possible -Temporarily substitute another attachment figure -Antidepressants

What are 10 Psychiatric Disorders Associated with Childhood or Adolescence?

-Intellectual disability -Learning disorders -Motor skills disorders -Communication disorders -Pervasive developmental disorders, e.g. autism spectrum disorders such as Asperger's -Attention deficit and disruptive behavior disorders -Feeding and eating disorders of infancy or early childhood -Tic disorders -Elimination disorders -Other disorders, e.g. attachment disorder

What are 4 interventions used to reduce risk taking behaviors in adolescents?

-Intervene at peer level, educational programs: Teen Institute (sobriety), Date Night (violence), Peer Mediation skills and programs -Support healthy recreational activities, relationships, physical outlets -Peer counseling, education more effective than adults' -Positive role models (parents, Big Brother/Sister)

*Major Depressive Disorder* *Assessment findings similar to adults except....* -Less ..... -More ...

-Less *spontaneous/outward expression of sadness and worthlessness* -More *irritability, acting out, somatization*(somatic complaints)

*Management of repetitive behaviors in PDD* >>Other responses depends on consequences, risks of the behavior: (hint: what do you do for each risk) -Low risk: -High risk:

-Low risk: *may be ignored (i.e., rocking) while at same time addressing triggers or contributing factors* -High risk: *protective headgear, environmental alterations to reduce hazards; if acute, temporary manual holds while calming*

*Adolescent Risk-Taking Behaviors* -May adolescents experiment with risk-taking behaviors, such as (5)? -Distracted and other unsafe _______ habits are significant health-affecting problems

-May adolescents experiment with risk-taking behaviors, such as *smoking, alcohol, unsafe sex, truancy or delinquent behaviors, and running away* -Distracted and other unsafe *driving* habits are significant health-affecting problems

*Separation and Divorce* -May experience impaired.... -May act out, causing....

-May experience *impaired ability to trust others, establish & maintain relationships in later life* -May act out, causing *disciplinary, drug/alcohol problems*

Explain death and grieving of the Preschool-aged? -May react... -Need.... -Helps...

-May react more to others' responses than to the death itself -Need reassurance -Helps if adults avoid euphemisms (e.g., "he went to sleep")

*Disrupted Attachment* may result from what? -May result from.......(2) -May lead to ........(4)

-May result from deficits in infant attachment behaviors, lack of responsiveness by caregivers to the child's cues, or both -May lead to reactive attachment disorder, feeding disorder, failure to thrive, or anxiety disorder

Having mother-child attachment is associated with what 2 things? And what is child-father attachment associated with?

-Mother-child attachment is associated with *perceived self-worth and physical appearance * -Child-father attachment is associated with *child-perceived school competence*

*Nursing Interventions, PDD's- PT1* -Need specific _______ interventions that are based on careful evaluation -Ensure ______ and ______ in environment -Teach _______ skills -Role model and promote ..... -Teach, promote appropriate ______ behavior -Support _______: caregiver respite & support as needed -Supplemental prenatal __________ may reduce incidence -____________________________ equipment helpful when stressed, acting out -Management of ________ behaviors -Take care to prevent....

-Need specific *behavioral* interventions that are based on careful evaluation -Ensure *predictability and safety* in environment -Teach *self-care* skills -Role model and promote *interaction, socialization* -Teach, promote appropriate *social* behavior -*Support family:* caregiver respite & support as needed -Supplemental *prenatal folic acid* may reduce incidence -*Comfort rooms, weighted blankets & other comfort* equipment helpful when stressed, acting out -Management of *repetitive behaviors* -Take care to prevent *victimization* (sexual, financial)

*PDD Pharmacologic Interventions-continued* -Note: the FDA has warned that, contrary to the beliefs of some, treatments such as chelation therapies, detoxifying clay baths, hyperbaric oxygen therapy, raw camel milk and essential oils are effective or ineffective in tx of autism? -The FDA has approved what 2 meds for treating autism-related irritability in children. -Families, staff may believe meds are the only or best answer when in fact other interventions are equally important. Meds may be overused, other interventions neglected.

-Note: the FDA has warned that, contrary to the beliefs of some, treatments such as chelation therapies, detoxifying clay baths, hyperbaric oxygen therapy, raw camel milk and essential oils are *ineffective for the treatment of autism and may in fact pose significant health risks.* -The FDA has approved *only* the *antipsychotics aripiprazole and risperidone* for treating autism-related irritability in children. -Families, staff may believe meds are the only or best answer when in fact other interventions are equally important. Meds may be overused, other interventions neglected.!!!!

*More non stimulants used adjunctively for ADHD* (3)

-Other antidepressants—primarily bupropion [Wellbutrin], citalopram [Celexa]) -Long-acting alpha-2 agonists such as guanfacine or clonidine -Antipsychotics, e.g. risperidone

*Interventions for ADHD patients* -planning: -Use what techniques: -be alert for what?

-Planning: include the family, treatment setting, and school -Behavioral/Cognitive behavioral techniques -For patients being treated with stimulants, be alert for possible diversion of meds to others by pt or by family; meds may also be stolen by peers, others.

Why is play helpful?

-Play can be used to help build rapport and acquire assessment data, and can be used during interviews and therapy sessions to facilitate the interaction; the therapist can participate in the play with the child, and/or observe the child at play (e.g. observe at school to see how he relates to peers).

What is play therapy used for? What does it involve?

-Play therapy uses play to help the child gain insight, express emotions or conflicts, learn new ways of expressing self or relating to others; -it can involve the use of games, playing house, role-playing, etc. and often uses toys and props (e.g. playhouses).

*SIDE NOTE:* -Poor abstract thinking interferes with..... -Grief may also occur in response to....

-Poor abstract thinking interferes with *comprehension of death and related issues.* -Grief may also occur in response to *loss of parent through divorce, overseas deployment of military, etc..*

*Risk Factors for Psychopathology(mental illness, or emotional dysfunction)* (hint: ADVERSE CHILDHOOD EVENTS, including: 6?)

-Poverty, homelessness—also increase risk for physical health problems, stigma, isolation, and educational underachievement, all perpetuating cycle of poverty -Child abuse and neglect -Out-of-home placement -Negative subcultures that endorse/model crime, drug abuse, etc -Substance abuse in parents, and/or in child him/herself -Mental illness in parents

What are 7 common childhood reactions to physical illness?

-Regression -Sleep and feeding difficulties -Behavioral problems (acting out) -Somatic complaints -Depression -Decreased school performance (worry, pain, internally distractions, impaired concentration, memory, etc)

*Behavioral/Cognitive behavioral techniques-ADHD* -Set clear limits with.... -Promote attention via? -Establish what before giving directions? -Encourage child to do homework in.... -Encourage what when doing tasks?

-Set clear limits *with clear consequences* -Promote attention *via a calm, predictable environment with minimal and controlled stimuli* -Establish *eye contact* before giving directions; *have repeat what was heard* -Encourage child to do homework *in a quiet place* -Encourage *one task/assignment at a time*

SIDE NOTE: People with Intellectual disability may also act out in positive ways, e.g. be very physically affectionate. Give some problems that can occur with this? And what problems can arise from this?

-Sexuality can also present problems as person may not be able to meet sexual needs in socially acceptable manner, e.g. may expose self, masturbate openly, touch others sexually out of curiosity or d/t poor impulse control or poor social skill -such actions can make placement in public schools, etc., problematic, esp, if adults do not understand the behavior or exaggerate the risk.

How may children act when they are sick? And what may younger pts do if their older brother/sister is sick?

-Sick children may also act out what they are feeling -via tantrums in the younger children to sabotaging treatment in older children

*Disruptive Behavior: --Decrease rule violations via:* -what training? -what type of solving? -set.... -use what approach?

-Social and conflict *resolution skills* training -*Problem-solving:* teach skills, role model & promote use -*Set limits* appropriately -*Behavioral approach:* reinforce desired behaviors, allow undesired behaviors to extinguish

*SIDE NOTE ADHD:* -Some believe that ADHD is over diagnosed or under diagnosed? -Note that recent research (2015) indicates that, contrary to intuition and popular belief, .....

-Some believe that ADHD is *over-diagnosed in children* and/or are philosophically opposed to specific tx's, e.g. meds. -Note that recent research (2015) indicates that, contrary to intuition and popular belief, *hyperactivity may actually be adaptive, helping the ADHD child to better focus or learn. One would think that it would be distracting instead, but this is not always the case*

*What occurs in Separation Anxiety Disorder? * -Suffer undue distress when faced with .... -Excessive worry about.... -_________ separating from parent (e.g. to go to school)

-Suffer undue distress when faced *with ordinary separations from major attachment figures* -Excessive worry about *separation, harm to parent* -*Resists* separating from parent (e.g. to go to school)

Explain death and grieving of the School-aged? -Unable to...... -Express grief through.....

-Unable to express feelings in a grownup way -Express grief through somatic complaints, regression, behavior problems, withdrawal, anger/hostility, reduced school performance

Explain death and grieving of Adolescents? -Understand death as an..... -May have a __________ idea of death -If parent has died (or is ill), may assume....

-Understand death as an *abstract concept* -May have a *romantic idea* of death *(increases suicide risk!!!)* -If parent has died (or is ill), may assume *parental role*

What are 3 stimulants used for ADHD?

-Vyvanse (lisdexamfetamine dimesylate [LDX]) -Ritalin (methylphenidate) -Adderall (dextroamphetamine and amphetamine)

Psychoeducation and family interventions focus on what? (2)

-can focus on many topics, and are individualized to the situation (though some are provided globally to at-risk families in general). -These can focus on parenting skills, maintaining sobriety, communication skills, discipline, mental illnesses and their treatment, behavioral interventions, vocational skills, etc.

What are 12 Common features in ADHD?

-easily distracted -"trouble listening" -unable to sustain attention -difficulty organizing, completing tasks -not following instructions -being forgetful -impulsive/acting without thinking -avoiding or failing to finish tasks and activities -lacking time awareness -incomplete tasks -taking too long to complete tasks -above lead to impaired school, other role performance

Worsening of ADHD symptoms may indicate what? is there tolerance with ADHD meds?

-pt is not taking meds>>>>he may be selling or giving away, others may be taking from him, or he may simply be nonadherent. -Although tolerance can gradually develop to stimulants, a sudden decrease in effectiveness is more likely to indicate that meds are no longer being taken as prescribed. Some who are prescribed stimulants share them with others who believe they enhance learning, reduce the need for sleep, etc.

SIDE NOTE: When a person with an Intellectual disability are frustrated, jealous, prone to act out (e.g. unable to control impulses, impaired communication), what can occur? And what can contribute to these type of behaviors?

-they can be assaultive of peers or others, e.g. one pt pulled a trach tube from another resident at MRDD home. -Impulsiveness contributes to this, as does poor frustration tolerance and very limited ability to cope or express self verbally (i.e. they act out).

*WHICH STIMULANT IS BELOW* -Regular form is taken bid or tid; extended release form is taken QD before school (less disruptive) -Similar abuse risk to Ritalin and other stimulants -Side effects similar to Ritalin plus tremor, constipation

Adderall (dextroamphetamine and amphetamine)

How should you asses a pt when considering ADHD?

Assess via direct observation, observing child and parent interaction, and teacher observations & ratings

*WHAT DISORDER IS BELOW* Persistent pattern of inattention, hyperactivity, and impulsiveness that is pervasive and inappropriate for developmental level

Attention Deficit Hyperactivity Disorder

What are the 2 types of Pervasive Developmental Disorders (PDD) mentioned in class?

Autistic Spectrum Disorders & Asperger's Disorder

What type of questions should you avoid? (examples)

Avoid leading questions, e.g. ask "What happened next?" instead of "Is that when he hit you?"

*PDD's* Who are the professionals who often have the best training and skills for assisting this population, important to consult them (along with special education professionals, etc.).

Behavioral Specialists

When considering Pharmacologic Interventions for PDD, we should caution what?

Caution *not to over-rely on meds and expect meds will be the answer to all needs* (behavioral and environmental interventions are equally important and should be tried first)

The adverse childhood events that occur, may cause what 10 things to happen to child? (hint: behavior/mood/responses, etc)

Child's responses may include: *Negative emotional responses and maladaptive coping may include detachment, rage, depression, antisocial behavior, low self-esteem, chronic dependency, poor school performance, self-injurious behavior, substance abuse, acting out, suicidality*

Children in particular often respond well to ________ even when they do not relate well (or at all) to peers or adults.

Children in particular often respond well to *animals* even when they do not relate well (or at all) to peers or adults.

*WHAT Disruptive Behavior Disorder IS BELOW* -Cruelty to animals -Aggressive behavior -Destruction of property -Serious violations of social norms

Conduct disorder

When does recognition of mental illness usually occur in children? And why?

Delayed recognition of mental health problems is common in children -parents & other adults may see it as "a stage" or a "behavioral problem", etc. d/t not wanting to imagine that their child has a serious mental illness (e.g. d/t stigma, shame). Adults can also exhibit denial, or lack knowledge of mental illnesses and thus fail to recognize their signs and symptoms. Persons outside the family may be reluctant to speak up d/t possible hostile response of parents, fear of intruding, or of a lawsuit if they say something, etc.

*WHAT DISORDER IS BELOW* -Recurrent and severe temper outbursts (3+ per week) that are inconsistent with the child's developmental level -Between these outbursts, the mood is irritable or angry much of the time -Child may seem easily, frequently frustrated

Disruptive Mood Dysregulation Disorder

*Oppositional defiant disorder* It is important to NOTE: if persistent irritable mood is a major factor then proper diagnosis may be what?

Disruptive Mood Dysregulation Disorder instead

END OF PDD -On to more disorders

END OF PDD -On to more disorders

What is an important health intervention to reduce related risks in adolescents?

Education is an important health intervention to reduce related risks.

T or F ADHD & ADD is a disorder that occurs in childhood and diminishes upon adulthood.

FALSE; ADHD and ADD often continues into adulthood and is often undiagnosed in adults;

T or F We always interfere with repetitive behaviors so they will be stopped.

FALSE; Note, however, that repetitive behaviors that are safe do not necessarily require intervention; they may serve a purpose, such as helping the person or cope with anxiety or overstimulation.

Fathers emotional support tends to do what regard to attachment theory?

Fathers' emotional support tends to enhance the quality of mother-child relationships and aids in positive adjustment by children

Can people get introuble with sharing/selling their ADHD meds?

Further, such sharing is a felony offense as Ritalin and similar stimulants are Schedule II drugs (wherein such diversion is a violation of the law for both those who give away or sell their meds, and for those who use them without a prescription).

GO OVER STIMULANTS MORE: (maybe look at marios or make more questions) (slide 31 and 32)

GO OVER STIMULANTS MORE: (maybe look at marios or make more questions) (slide 31 and 32)

What is the impact of Separation and Divorce has on a child?

Impact on child varies with child's age, how parents handle the divorce (e.g. triangulation*, recrimination, custody struggles), available supports, coping ability, presence of other stressors

In general what should we do to Manage repetitive behaviors?

In general: avoiding undue stress and demands when vulnerable, redirecting, distraction, using positive reinforcement, stimulation reduction

What occurs in home therapy?

In in-home therapy, the professional observes the family in their home setting and intervenes directly in real time; it can be combined with traditional in-office treatment or be a stand-alone approach.

What is attachment theory?

Infants have an innate need to bond, tend to bond to one primary parental figure, usually the mother

*Disruptive Mood Dysregulation Disorder* Is a common reason for ________ problems, often is a presenting complaint in pediatric settings.

Is a common reason for *school problems*, often is a presenting complaint in pediatric settings

SIDE NOTE CONDUCT DISORDER: It is important to not assume what when caring for a child with this? and what can help the disorder?

It is very important to devaluate(reduce its worth?) for this disorder rather than to simply assume the child is delinquent; incarceration does not change behavior caused by this disorder (it may even instead worsen it significantly, and can give the child opportunities to learn how to be a criminal from more-hardened cellmates) -but therapy for the pt and family can help

When stepfamilies develop, they can lead to what?

Lead to other problems

What do behavior specialists help PDD patients do? and what is result?

Lists of chores, activities, etc. help provide structure -consistent structure and routines help reduce anxiety, promote comfort and enable greater interaction.

What is the inteligence level of PDD: Asperger's Disorder?

Normal or above normal intelligence, good verbal skills

SIDE NOTE: How does developmental disorder/ Intellectual disability vary?

Note that people vary in what aspects of functioning are limited or delayed, e.g. some persons have sound ability to read or do math, but extremely poor social skills, while others are just the opposite and may be assumed to be "normal" when there are actually significant functional deficits (i.e. high functioning in some areas does not mean high functioning in all areas).

Nurses need to carefully distinguish between what 2 things when considering ADHD?

Nurses need to carefully distinguish *normal distractibility* and *increases in activity from abnormal (parents or school personnel may exaggerate behaviors, esp, if child is acting out or disruptive for other reasons* (may press of ADHD meds, other ADHD treatment when problem is either more complicated than ADHD alone, or not ADHD at all)

*WHAT Disruptive Behavior Disorder IS BELOW* -Disobedience, resistance -Argumentativeness -Angry outbursts (overreactive) -Low frustration tolerance -Tendency to blame others

Oppositional defiant disorder

OVERVIEW What are 2 Disruptive Behavior Disorders?

Oppositional defiant disorder Conduct disorder

SIDE NOTE CONDUCT DISORDER: Oppositional defiant disorder can be __________ as the child matures, sources of emotional distress are addressed, etc.

Oppositional defiant disorder can be *self-remitting* as the child matures, sources of emotional distress are addressed, etc.

Is triangulating common? and what is important to educate to parents?

Parents who triangulate, i.e. try to get the child to unite with them in opposition to (or hatred of) the other parent, can cause great distress/dysfunction in children. Sadly, this is not an uncommon dynamic. -It is very important to educate parents about this and other behavior r/t their divorce that may harm children, who can become pawns in the battle between mom and dad.

What behaviors are present in PDD: Asperger's Disorder? (3)

Physical clumsiness, overactivity, stereotypical behaviors may be present

PDD: Autistic Spectrum Disorders is thought that what plays a role in causing it?

Reduced inhibitory activity by GABA may play a role

*WHICH STIMULANT IS BELOW* -Available in regular, sustained release (educate pt not to chew), and long acting (Concerta) forms -Regular form lasts 3-4 hours so is needed more often, can be disruptive in school (peers notice, tease or bully pt) -Regular form is usually bid or tid dosing, dosage varies with individual, typically 10-60mg/day -Side effects include nervousness, dizziness, insomnia, headache, tics or dyskinesias, GI distress (pain, nausea), decreased appetite, increased pulse or BP, weight loss, restlessness, agitation -"" potentially dangerous SE's: palpitations, SOB, seizures, psychosis; risk of sudden death if pt has cardiac disease

Ritalin (methylphenidate)

Why do repetitive behaviors occur in PDD & do they need tx for them?

Serve a purpose and may be adaptive if not injurious or disruptive (e.g. help manage anxiety)

What may cause both/either the child or parent less likely to bond? and causing nurse to assess for what in child?

Sick children and children of (medically or psychiatrically) sick parents are less likely to bond well. -Nurses need to also assess for physical causes of failure-to-thrive syndrome and not assume it is d/t poor parenting/bonding (can be d/t malabsorption syndromes, etc.).

PDD: Asperger's Disorder is similar to what other disorder? but also different in what way?

Similar to autistic disorder -but typically no clinically significant delays in language acquisition or cognitive development

SIDE NOTE: Explain how change can affect people with intellectual disabilities?

Some persons with intellectual disability may be intolerant of any change in their routine or environment; any change should be introduced gradually and staff/family should be prepared to provide additional support and supervision during this process.

*Disruptive Mood Dysregulation Disorder* -Symptoms must begin before age ____ and persist for more than _____ for this diagnosis

Symptoms must begin before *age 10* and persist for more than *a year* for this diagnosis.

When are NON-STIMULANT MEDS USED IN ADHD?

The following are usually used adjunctively in children who do not respond adequately to stimulants alone.

Why do Family, MRDD staff, etc may press for meds to be prescribed for PDD? (3)

They may have mistaken beliefs or unrealistic expectations that meds will help severe behaviors when other interventions may be needed as well, or instead (i.e. may believe that if MD will just prescribe enough of the right med, person will not be self-injurious or assaultive, may not believe that such behavior might be expression of emotional distress instead of psychiatric pathology). -Some are biased to believe that meds are the most important intervention, or the most effective intervention, or that the problem will "go away" if only the right medication is prescribed. -Such persons may be very resistant to encouragement to use non-pharmacological approaches, or to efforts to educate them about a med not being medically indicated (they may have heard from others that the med works and follow this belief despite clinical evidence to the contrary).

*WHICH STIMULANT IS BELOW* -inhibits reuptake of DA and NE and elicits the release of monoamine neurotransmitters -is a pro-drug: is itself inactive until it is metabolized to amphetamine -Result is less abuse potential (d/t delayed effects) and longer duration of action -Side effects similar to other amphetamine products

Vyvanse (lisdexamfetamine dimesylate [LDX])

The use of stimulants/ ADHD med can cause a person without ADHD to have what affect? does it improve their learning?

a heightened sense of alertness -it is not clear that they actually improve learning.

What often occurs in ADHD patients once they are adults in regards to tx?

another problem is that about 40% of those tx'd for ADHD as adolescents believe they no longer need tx as adults and stop the tx prematurely.

Explain the rationale/reasons for interviewing child separately?

as it may be threatening to parents otherwise (and it may be threatening even if you do).

What should be considered first when treating PDD?

behavioral and environmental interventions are equally important and should be tried first, then secondly try pharmacologic interventions

In Disruptive Mood Dysregulation Disorder, child does not meet criteria for what other disorder?

bipolar disorder

Why are Mood disorders are often overlooked in children?

can present as behavior problems, be mistaken for ODD or other disorders. (Careful assessment is needed.) Much of child mental health care is delivered by pediatricians d/t difficulty accessing child mental health professionals (shortage of child psychiatrists, etc.); in such cases child psychiatrist or APRN should be consulted ASAP and should also assess the child to confirm the diagnosis and affirm the treatment.

What is the treatment for Disruptive Mood Dysregulation Disorder?

cognitive and/or behavioral, mood disorder meds may be helpful

What do Environmental alterations include? (we do this when pt is performing high risk repetitive behavior)

could include special furniture without sharp edges, padding on selected surfaces, etc.

Much of child mental health care is delivered by pediatricians, why? and what should occur if pediatrician diagnoses child with mental illness?

d/t difficulty accessing child mental health professionals (shortage of child psychiatrists, etc.) - in such cases child psychiatrist or APRN should be consulted ASAP and should also assess the child to confirm the diagnosis and affirm the treatment.

What helps children going through separation and divorce?

educate parents about children's needs, support regular & predictable visitations, reduce conflict between parents, maintain usual routines, family counseling & support

Separation anxiety is often expressed in what 2 ways?

in nightmares, somatic complaints

Preschoolers are very influenced by who?

influenced by how others behave, picking up on such cues and modeling what they see. Magical thinking may cause child to see death as temporary (as in cartoons). Poor abstract thinking interferes with comprehension of death and related issues. Grief may also occur in response to loos of parent through divorce, overseas deployment of military, etc..

SIDE NOTE: Persons with severe or profound ID typically are where? And require what? What is the concern when person is distressed?

institutionalized and require significant care d/t poor functioning and/or safety issues -self injury is relatively common esp. when the person is in distress (head banging, biting self, etc.; pt may amputate fingers over time just via repeated biting).

What does social skill training involve?

involves all the abilities one needs to interact successfully with others, e.g. recognizing the other person's emotional state, assertiveness, how to convey information supportively and diplomatically, and how to resolve conflict

What is Psychopathology?

mental illness, or emotional dysfunction in this case.

Explain the impraired social communication in PDD: Autistic?

pronounced inability to engage in, and lack of interest in, social interactions; delays or abnormal functioning in social interaction, language (pronoun reversals and abnormal intonation), or symbolic or imaginative play prior to age 3 years; concrete thinking

Give 3 examples of restricted, repetitive and stereotyped patterns of behavior? and why are they performed?

rocking, hand flapping, self-injurious behavior -some may be soothing, some may express distress

What are the interventions for Childhood Schizophrenia?

similar to adult disorder but adjusted to child's developmental level and functional abilities (Family education is very important!!)

*SIDE NOTE: Asperger's Disorder* Often have difficulty recognizing emotions in others, understanding abstract concepts, understanding humor or sarcasm. This contributes to what 3 things occurring?

social rejection, bullying, and isolation and can prompt acting out.

When people say Separation anxiety "runs in family" may simply reflect what?

the child picking up on anxiety-proneness in the adults around him

SIDE NOTE CONDUCT DISORDER: Conduct disorder is akin/similar to what other disorder, and may be converted to this disorder in adulthood?

to child version of *antisocial personality disorder* ODD can be self-remitting as the child matures, sources of emotional distress are addressed, etc. It is very important to devaluate for this disorder rather than to simply assume the child is delinquent; incarceration does not change behavior caused by this disorder (it may even instead worsen it significantly, and can give the child opportunities to learn how to be a criminal from more-hardened cellmates), but therapy for the pt and family can help

f you believe there is reason to withhold information from a parent you are encouraged to do what?

to consult a senior or supervising person with expertise in such matters.

Why is it Important to screen for prodromal symptoms in at-risk children?

tx of prodromal may prevent conversion to full disorder or improve prognosis (research is mixed)