Mental Health #9

Front 1

Emotionally disturbed children often meet the criteria for more than one diagnostic category.
What are some examples?

Back 1

ADHD with:
1. 90% with juvenile-onset bipolar disorders
2. 90% of children with oppositional defiance
3. 50% with conduct disorder disorder

Front 2

What is the prominent comorbid condition?

Back 2

ADHD

Front 3

Childhood depression is associated with high incidence of comorbidity:

Back 3

Children with depression:
1. 20-80% have conduct or oppositional defiant disorders.
2. 30-75% have anxiety disorders.
3. 5-60% display s/s of ADHD

Front 4

What are implicated in a number of mental disorders, e.g. autism, bipolar, schizophrenia, ADD, and mental retardation?

Back 4

Hereditary factors

Genetic studies indicated an 80% heritability for ADHD.

Front 5

Vulnerability to these disorders exist even when a child is...?

Back 5

Vulnerability to these disorders exist even when a child is not being raised by the biological parents.

Front 6

Because not all vulnerable children develop mental disorders, it is assumed that what must take place??

Back 6

It is assumed that:

1. constitutional resilience (coping mechanisms) and
2. supportive environment

play roles in keeping the disorders from developing.

Front 7

Is the style of behavior a child habitually uses to cope with the demands and expectations of the environment.

Back 7

Temperament

Front 8

What is is thought to be genetically determined. It may be modified by a parent-child relationship with positive or negative results?

Back 8

Temperament

Front 9

(Temperament: In the case of an individual showing the difficult-child temperament)=
if the caregiver is unable to respond positively to the child, there is a risk of:

Back 9

insecure attachment,
developmental problems
future mental disorders.

Front 10

What Social and Environmental Factors increase the incidence of mental disorders: (6)

Back 10

Severe marital discord,
low SES,
large families and overcrowding,
parental criminality,
maternal psychiatric disorders
foster care placement.

Front 11

Social and Environmental Factors:
The greater the number of the stressors, the greater the?

Back 11

the greater the incidence of mental disorders.

Front 12

The abuse of children and traumatic life events can lead to:

Back 12

insecure attachments and number of psychiatric disorders, such as
PTSD,
Dissociative disorders,
depression.

Front 13

Cultural and Ethnic Factors: Culture shock and immigration may put children in difficult positions, with differences in:

Back 13

expectations,
presence of stressors, and
support or lack of support by the dominant culture

effects the child by:

Hint 13

effects child's:
1. development
2. risk of mental, emotional, and academic problems.

Front 14

The term has been used to denote the relationship endowment and environmental factors.

Back 14

Resiliency

Front 15

Children with resiliency have these following characteristics:

Back 15

1. A temperament that can adapt to changes in the environment,
2. The ability to form nurturing relationships with other adults when a parent is not available.
3. The ability to distance himself or herself from emotional chaos of the parent or the family,
4. Good social intelligence,
5. The ability to use problem solving skills.

?Other studies have identified the cushioning effect of family stability in the face of poverty and adversity. ?

Front 16

The nurses role is to?

Back 16

The nurses role is to foster these characteristics and environmental supports to keep the at-risk child from developing emotional and mental problems.

Front 17

A mentally disturbed child/adolescent is one whose progressive personality development is hindered or arrested by:

Back 17

a variety of biosychosocial, spiritual factors, which results in impairments in the capacities expected of a child of his/her age, physical and cognitive endowments.

Front 18

The personality of a mentally healthy child/adolescent progresses with:

Back 18

only minor regressions as the
--individual masters developmental tasks
--learns to love, work, and play with satisfaction.

Front 19

Types of assessment, Box 32-2, pg. 638.
Data collection methods include: (4)

Back 19

1. Screening,
2. testing (neurological,psychological, intelligence),
3. observing, and interacting with the child/adolescent.
4. Histories are taken from parents,caregivers, the child (when appropriate) or adolescent, and other family members.

Front 20

The observation-interaction part of a mental health assessment begins with what?

Back 20

Begins with a semi-structured interview in which the child or the adolescent is asked to describe life at home with parents.

Front 21

What techniques are used in the interview?

Back 21

1. Play technique is used during the interview.
2. Developmentally appropriate games are a great way to interview children. Games can be used with adolescents also depending on the age.
3. It is important to observe the interaction between the family members.

Front 22

Mental status exam is similar as in adults. Developmental assessment provides information about..?

Back 22

current maturational level.

These data are then reviewed in relation to..?

Hint 22

the child’s chronological age to identify developmental lags and deficits.

Abnormal findings are often related to stress and adjustment problems.

Front 23

Suicide Risk: Number of suicidal children and adolescents increase each year and suicide increases with what?

Back 23

increases with age.

Suicide is the third leading cause of death in adolescents

Front 24

Some children make idle threats about killing themselves. Areas to assess are the following: (4)

Back 24

1. Suicidal thoughts, threats, and attempts
2. Circumstances and motivation at the time of suicidal thoughts or behaviors
3. Concepts about suicide and death
4. Depression and other moods of feelings (anger, guilt, and rejection). These areas are also applicable when assessing adolescents but more detailed questions should be asked about listening to music or reading books with morbid themes.

Front 25

Assessing lethality is complicated in young children and adolescents because of the..?

Back 25

Because of the immature ego they have a distorted concept of death and lack of understanding the lethality. E.g. a child may be highly suicidal but believe that a few aspirin will cause death.

Front 26

Is viewed as a behavioral syndrome resulting from abnormal brain function of unknown etiology.

Back 26

Autistic Disorder: Autism

Front 27

s/s of Autistic Disorder: Autism

Text, pg. 640, Symptoms of Autism 1-3.

Back 27

1. Problems with left hemisphere functions (e.g., language,logic,reasoning) are evident
2. music and visual-spatial activities may be enhanced.
3. Usually first observed before age of 3, noticed by the mother when the infant fails to interact with others or be socially responsive thru eye contact or facial expressions.

Front 28

Asperger’s Disorder vs. Autism

Back 28

1. more high functioning autism.
2. Appears to have a later onset and no significant delay in cognition or language is noted.
3. As in autism, restricted and repetitive patterns of behavior and idiosyncratic interests (e.g., fascination with remembering train schedules or dates) may develop.
4. Problems with social relationships become more noticeable at school age and adulthood.

Front 29

Children with ADHD show an inappropriate degree of ?

Back 29

inattention,
impulsiveness
hyperactivity.

Front 30

ADHD occurs in various cultures and difficult to diagnose before ?

Back 30

before 4 years of age

Front 31

ADHD is most often detected when?

Back 31

The disorder is most often detected when the child has difficulty making the adjustment to elementary school and exhibits:
excessive fidgeting,
restlessness,
talkativeness,
impulsivity,
difficulty sticking to and completing tasks.

**The symptoms worsen in situations requiring sustained attention.**

Front 32

The attention problems and hyperactivity contribute to

Back 32

1. low tolerance for frustration,
2. temper outbursts,
3. labile moods,
4. poor school performance,
5. rejection by peers
6. low self-esteem.

Front 33

Children with ADHD are often concurrently diagnosed as having what?

Back 33

oppositional defiant disorder

Front 34

ADHD is often associated with what?

Back 34

Tourette’s disorder; at least 25% of males with Tourett’s disorder have ADHD

Front 35

Is a recurrent pattern of negativistic, disobedient, hostile, defiant behavior toward authority figures without serious violations of the basic rights of others.

Back 35

Oppositional Defiant Disorder

Front 36

S/S of Oppositional Defiant Disorder:

Back 36

Such children exhibit
1. persistent stubbornness, and argumentativeness,
2. persistent testing of limits
3. an unwillingness to give in or negotiate
4. a refusal to accept blame for misdeeds.

Front 37

Oppositional Defiant Disorder is evident before what age?

Back 37

This disorder usually is evident before age 8 and is more common in males (until puberty when male-female rates are equal).

Front 38

Is characterized by a persistent pattern of behavior in which the rights of others and age-appropriate societal rules are violated.

Back 38

Conduct Disorder

Front 39

Predisposing factors for conduct disorder are:

Back 39

1. ADHD,
2. parental rejection,
3. oppositional Defiant Disorder,
4. inconsistent parenting,
5. early institutional living, etc.

Front 40

Childhood onset conduct disorder occurs prior to what age?

Back 40

Prior age 10 and is found mainly in males who have poor peer relationships, and show lack of feelings of guilt or remorse.

Front 41

Conduct Disorder: In adolescent onset-individuals demonstrate..?

Back 41

less aggressive behaviors and more normal relationships.

Front 42

Conduct Disorder: In adolescent onset-individuals.
Examples of behaviors:
Both, Males, Females

Back 42

1. misconduct with their peer group
2. early onset of sexual behavior,
3. substance abuse,
4. smoking,
5. drinking.
*Males: fight, steal, and vandalize,
*Females: lie, are truant, run away, abuse substances and engage in prostitution.

Front 43

Interventions for ADHD (4)

Back 43

1. behavior modification
2. medication,
3. special education programs
4. psychotherapy.

Front 44

What is the most widely used psychostimulant because of its safety and simplicity of use?

Back 44

Methylphenidate (Ritalin)

Front 45

Other medications for ADHD:

Back 45

1.Adderall has been proven effective,
2. Concerta, an extended-release formula, allows once daily dosing, which helps keep the existence of the condition private.

Front 46

For Oppositional and conduct disorders interventions focus on:

Back 46

Correcting the child/adolescent’s faulty personality (ego and superego) development, which involves generating more mature and adaptive coping mechanisms.

Front 47

Is used to change the pattern of misconduct and to foster the development of internal controls, both cognitive and emotional.

Back 47

Cog-b therapy

**Families are involved,are given support, and taught parenting skills (text, pg. 646, box 32-3).

Front 48

Children and adolescents become excessively anxious when separated from home or parental figures, known as:

Back 48

Separation anxiety disorder

Front 49

Separation anxiety disorder may develop when?
what mood accompanies the anxiety?

Back 49

May develop after a major stress, such as a death of a relative or pet, an illness, move, change of schools. A depressed mood often accompanies the anxiety.

Front 50

Can occur at any age and has now been recognized in children.

Back 50

Posttraumatic Stress Disorder (PTSD)

Front 51

Assessment Guidelines for Anxiety Disorders: What to assess for: (5)

Back 51

1. Assess the quality of the relationship between child and parents or caregivers for evidence: a. anxiety,
b. conflicts,
c. difficulty of fit between child’s and parents’ temperaments.
2. Assess for recent stressors and their severity, duration, and proximity to the child.
3. Assess the parents’ understanding of the developmental norms, and parenting skills.
4. Assess the developmental level and determine if regression has occurred.
5. Assess for trauma exposure.

Front 52

Rather than reliving the traumatic event as an adult might, younger children with this disorder tend to react with behaviors indicative of internalized anxiety. In older children, it is more often externalized.

Back 52

Posttraumatic Stress Disorder (PTSD):
adult vs. children

Please read text, pg. 646, PTSD Behaviors in preschool and school age children.

Front 53

Interventions for Anxiety Disorders (5)

Back 53

1. Protect the child from panic levels of anxiety by acting as a parental surrogate and providing for biological and psychosocial needs.
2.Accepting regression but giving emotional support to help the child progress again.
3. Increase the child’s self-esteem and feelings of competence in the ability to perform, achieve, or influence the future.
4. Help the child accept and work thru traumatic losses.
5. Medications such as antihistamines, antidepressants, and anxiolytics are used.

Front 54

The most frequently diagnosed mood disorders in children and adolescents are (3)

Back 54

1. major depressive,
2. dysthymic (less severe)
3. bipolar disorders.

Front 55

Mood disorders: s/s adult vs. child?

Back 55

Symptoms may be similar to adults. --Children have more somatic complaints, be critical of themselves, and others, and feel unloved.
--Both may manifest irritability and aggressiveness.

Front 56

The acting-out behaviors once considered symptoms of ?

Back 56

The acting-out behaviors once considered symptoms of masked depression, can clearly be related to the presence of mood disorders.

Front 57

Is characterized by motor and verbal tics that cause marked distress and significant impairment in social and occupational functioning

Back 57

Tourette’s Disorder

Front 58

Tics appear when?

Back 58

Tics may appear as early as 2 yrs., but the average age of onset for motor tics is 7.

Front 59

Motor tics involve what?

Back 59

Motor tics usually involve the head, but they can involve other parts of the body and change in location and frequency.

Front 60

Vocal tics include what?

Back 60

Vocal tics include production of words and sounds (barks, grunts, yelps, snorts, sniffs).

Front 61

Interventions used for mood disorders (??)

Back 61

1. Family and group therapy.
2. Milieu therapy for structuring inpatient, residential, and day tx programs.

Front 62

The nurse collaborates with other health care providers in structuring the milieu and maintaining a therapeutic environment to provide...?

Back 62

To provide:
1. physical and psychological security, 2. promote growth and mastory of developmental tasks.

Front 63

The physical milieu is designed to ..?

Back 63

designed to provide a safe, comfortable place to live, play, and learn, with areas for private time and group activity.

Front 64

Is based on principle that behavior which is rewarded is more likely to be repeated.

Back 64

Behavioral therapy

Please read text, pg. 650, box 32-5.

Front 65

Interventions

Back 65

In your text please read Time-out, Play therapy,Therapeutic games, and therapeutic drawing on pgs. 651-652.
Text pg. 507, Table 25-1.
Text. Pg. 516, Table 25-6.
Please see workbook pgs. 221-226, and 263-268.