Child Adolescent Psychiatric Disorders

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hallmark characteristic of autism

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inability to maintain eye contact

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other characteristics of autism

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limited functional play, GI symptoms, speech/language delays

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Autism risk factors

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genes, genetic disorders (ex. tuberous sclerosis), drugs during pregnancy (thalidomide, valproic acid); maternal/paternal age over 40; meningitis

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What disorders make up the greatest percentage of child/adolescent psychiatric disorders?

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ADHD and learning disabilities

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contributing factors of psychiatric disorders

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genetics, temperament, environment, health status, family system (parental ability and stress), education

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Executive function (thinking) deficits-observable in....

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children with ADHD, oppositional defiant disorder, some learning disabilities, autism and aspergers; any child w/ low frustration tolerance, temper outbursts, inflexibility

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Errors in Executive Functioning

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organization and planning!; anticipating problems, forming goals, "working memory", ability to strategize to solve problems, ability to define a problem, consider forethought and previous experience, separate affect from problem

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inability to process social info and work through "thinking" steps for social processing quickly

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social impairment

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common characteristics: inflexible-explosive children

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frustration difficult to manage emotionally, difficult to modulate and control emotions, low frustration threshold and tolerance, limited adaptability (cannot change plans, activities, etc.), concrete, rigid, black and white thinking, meltdowns, "out of the blue" explosions, inflexible about specific issues (ex. the way clothes feel)

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disorders in which executive and social learning is delayed

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ADHD, ODD, conduct disorder, aspergers, autism, learning disabilities

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subtypes of ADHD

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inattentive, hyperactive, combined

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criteria for diagnosis of ADHD

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inattention, hyperactivity, impulsivity ("blurts out"); inattention must not be result of another disorder

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presentation of symptoms for ADHD (3)

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2 or more settings; more than 6 months; before age 7

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common comorbid conditions of ADHD

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ODD, Conduct disorder, depression, anxiety, learning disorders, bipolar disorder

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behavior may be more evident in one setting and not another

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ODD

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lacks empathy, low self-esteem, temper outbursts, unable to handle frustration

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characteristics of conduct disorder

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conduct disorder behaviors (mild to severe)

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lies, cons others, runs away from home/truant from school, bullies others, sets fires, uses weapons, forces sexual activity

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etiology of conduct disorders

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genetic vulnerability, child abuse history, environmental adversity, poor family functioning, parent w/ antisocial personality, substance abuse, mood disorder or schizophrenia, ADHD; socioeconomic disadvantages

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SAD

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constant thoughts and intense fears about safety of parents

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signs of SAD

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overly clingy, panic or tantrums, trouble sleeping or nightmares, refusing to go to school, extreme worries about sleeping away from home

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assessment of anxiety disorders

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complete biopsychosocial assessment is paramount; interviewing w/ consideration of child's developmental leve, parent-child interaction, interview separately

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interviews to assess for anxiety disorder

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parents and children rarely agree on symptoms; use variety of techniques-play,drawing,etc.; get thorough developmental history-settings, behaviors, age of onset; does it affect child academically? (school data)

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may mimic symptoms of ADHD (2)

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family history-psychosocial stressors; ex. death in family; chronic conditions-ex. asthma/allergies

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most effective treatments for anxiety disorders

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prevention and early intervention

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treatment-anxiety disorders-school aged children

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treatment w/ family, school, and child; work on improving school performance

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adolescent treatment of anxiety disorders

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skill development in conflict resolution, anger management, social skills; address substance use

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stimulant meds may exacerbate these if untreated

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co-morbid psychiatric conditions (ex. anxiety or depression)

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collaborative problem solving

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establish environment for child to learn, teach goals, three steps-empathy, define problem, invitation-brainstorm solutions (realistic and mutually satisfactory)

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goals to teach

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flexibility and adaptability, frustration tolerance, problem solving

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ADHD nursing care (7)

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safety, short and clear explanations, simple instructions-one at a time, structured daily routine, break tasks into smaller portions, get child's attention (eye contact), educate about meds

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ADHD meds

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start low and go slow; Ritalin, Dexedrine, Adderall, Cylert, SNRI; make the child "available" for learning

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nursing care-conduct disorder

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teaching-use Greene's model, limit setting (state rules and consequences), provide structure, be nonjudgmental, neutral in setting limits, work on coping skills and self-esteem, model social skills