Chapter 18Disorders and Issues of Children and Adolescents

Chapter 18Disorders and Issues of Children and

Adolescents

Chapter 18Disorders and Issues of Children and

Adolescents

Copyright © 2016 Wolters Kluwer • All Rights Reserved

Types of Mental Disorders in Children and Adolescents

Types of Mental Disorders in Children and Adolescents

• Neurodevelopmental disorders

• Intellectual developmental disability

– Deficits in general mental abilities such as reasoning, problem-solving, planning, abstract thinking, judgment, academic learning, and learning from experience (DSM-V)

– Signs and symptoms

o Intellectual functioning significantly below average; IQ ≤70

o Levels: mild ~ moderate ~ severe ~ profound

– Incidence and etiology: biologic, psychosocial


Types of Mental Disorders in Children and Adolescents (cont.)


• Language and communication disorders

– Impairment in both verbal and sign language

– Difficulty in acquiring and using language

• Deficits in vocabulary comprehension or production


• Limited speech, vocabulary

• Expressive or mixed disorders

– Incidence and etiology




• Speech sound disorder

– Failure to use sounds or articulate intelligibly

– Hearing impairment in many cases


• Stuttering: repetitive or prolonged sounds or syllables, including pauses + monosyllabic broken words

o Trigger: increased levels of anxiety/stress





• Autism spectrum disorder: range of complex neuro-developmental disorders involving delayed development of various basic skills

– Communication; socializing with others

– Processing, understanding external input

– Autistic disorder: severe abnormal development of external social interaction and communication

• Signs and symptoms: lack of language development; unresponsive to interaction; nonverbal behaviors; inflexible, consistent routines

• Incidence and etiology




• Attention-deficit/hyperactivity disorder

– Persistent pattern of inattention, hyperactivity, or impulsive behaviors, with greater frequency than age-appropriate

– Signs and symptoms: must be present ≥6 months

• Continual, often destructive physical activity

• Low tolerance of frustration





• Specific learning disorder

– One’s standardized testing performance in reading, mathematics, written expression are significantly below expected norm

– Dyslexia: inability to process incoming sensory stimuli with correct interpretation

• Signs and symptoms: reading, spelling, writing abilities inconsistent with intelligence of student





• Disruptive, impulse-control, and conduct disorders

– Problems in self-control of emotions and behaviors which violate rights of others

– Oppositional-defiant disorder: repetitive pattern of angry mood, negative/defiant/hostile behavior toward authority figures

• Signs and symptoms

o Incessant arguing with adults; active defiance

o Vindictive; spiteful; blame others for behaviors





• Disruptive, impulse-control, and conduct disorders (cont.)

– Intermittent explosive disorder: angry, aggressive outbursts to minor situation (usually) with rapid onset, typically lasting ≤30 minutes


o Impulsive, aggressive response significantly out of proportion to stressor

o Chronic pattern; no warning period of behaviors





• Disruptive, impulse-control, and conduct disorders (cont.)

– Conduct disorder: repetitive + continuous behavior which infringes on basic rights of others, defies societal rules/norms

• Signs and symptoms: aggressive actions which result in/threaten harm to others or animals

o Initiate hostile, bullying behavior; assaultive

o Commonplace to lie, manipulate others





• Anxiety disorders

– Separation anxiety disorder: excessive anxiety related to separation from home, attachment figures


oUncomfortable to the point of misery when separation occurs

o Somatic complaints possible

o Anxiety range: from uneasiness to panic + depression






– Tic disorder (Tourette’s): sudden, repetitive, arrhythmic, stereotyped motor movement or verbal speech; never symptom-free ≥3 months


o Simple tics: eye blinking; nose wrinkling; neck, shoulder jerking; grimacing

o Complex tics: hand gestures; facial contortions; jumping; retracing steps; hopping; posturing





• Elimination disorders

– Encopresis: repeated passage of feces into inappropriate places

– Enuresis: repeated episodes of urine incontinence during day or night


• Usually involuntary, may be intentional behavior



Treatment of Child + Adolescent Disorders

Treatment of Child + Adolescent Disorders

• Neurodevelopmental disorders

– Combined approach of therapies, behavior management interventions

• Learning and communication disorders

– Mainstream education with added speech, language therapies


– Cognitive-behavioral therapy, group therapy, antianxiety medication

• Elimination disorders

– Rule out physical cause; behavioral approaches


Application of the Nursing ProcessApplication of the Nursing Process

• Assessment

– Assess all potentially contributing factors to child’s behavior

– History of behaviors

– Thorough medical and emotional assessment of child

– The child’s ability to communicate and interact with family members


Application of the Nursing Process (cont.)Application of the Nursing Process (cont.)

• Selected nursing diagnoses: diagnosis from data review

• Expected outcomes

– Target realistic, measureable outcomes

• Interventions: cognitive-behavioral, safety/security-based

– Include parents

• Evaluation

– Criteria dependent upon problematic behavior being addressed


QuestionQuestion

Which of the following is not a specific listing in the DSM-V?

A. Dyslexia

B. Conduct disorder

C. Attention deficit/hyperactivity disorder

D. Asperger’s syndrome


AnswerAnswer

D. Asperger’s syndrome

• Rationale: The DSM-V no longer includes Asperger’s syndrome, which is now included in the broader category of ASD.


QuestionQuestion

Which of the following developmental disorders is characterized by an IQ of 70 or below?

A. Intellectual developmental disability

B. Autistic disorder

C. Asperger’s syndrome

D. Psychosis


AnswerAnswer

A. Intellectual developmental disability

• Rationale: According to the DSM-V, intellectual developmental disability is characterized by an intellectual functioning that is significantly below average (IQ of 70 or lower).


QuestionQuestion

Stuttering is a characteristic of

A. Attention deficit/hyperactivity disorder

B. Developmental coordination disorder

C. Speech sound disorder

D. Separation anxiety disorder


AnswerAnswer

C. Speech sound disorder

• Rationale: Speech sound disorder is a failure to utilize sounds or articulate syllables intelligibly during speech. Stuttering (prolonged or repetitive sounds or syllables that include pauses and broken words) is a common characteristic of the disorder.

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Chapter 18Disorders and Issues of Children and Adolescents