Childhood Disorders,

ODD, Conduct,
ADHD, ADD.

 When a child demonstrates an absence of growth,

an inability or refusal to change, or a failure to
achieve the developmental tasks of his or her age
group, mental health assistance should be sought.

The major mental health problems of childhood are

grouped into seven categories.

Environmental, parent-child interactions,

emotional, behavioral, eating/elimination
problems, developmental, pervasive
developmental.

Morrison-Valfe 142

Environmental problems
Poverty and mental health have a strong
correlation. Poor children scored much lower on
IQ test and have higher rates of anxiety,
unhappiness, and fearfulness. Head start help
children prepare school and work to improve
thinking and social skills

Homelessness experience behavioral

problems, developmental delay, sleep disorders,
aggression, inappropriate interactions with
adults.
Morrison-Valfe 142

Nursing actions for homeless

clients.
Psychological- Know your own feelings about
homelessness. Approach clients with a positive attitude.

Clients interview- delay asking questions about

occupation, address, and education until later in the
interview, promise information is confidential, ask
simple concrete questions.

Health assessment- educate as you asses, asses

children for signs of abuse, malnutrition, neglect.

Discharge plan- ask question, follow up

appointments, write down all instructions.
Morrison-Valfe 143

Environmental problems
Neglect and abuse
Abuse- causing harm to or maltreating another.
Neglect- not meeting a child's basic needs.
Contribute to chronic anxiety and depression in
adulthood

Morrison-Valfe 143

Parent Child Interactions

When a parent is unable to meet the needs of a
child

Signs and symptoms: feeding and sleeping

problems, developmental delay, FTT, inadequate
physical care or abuse, frequent visits to the
physician, and excessive parental worry.

Nursing actions- supporting and educating the

parents and helping them develop a more effective
and appropriate child care skills.
Morrison Valfre 144

Emotional problems
Occur in children when they cannot successful cope with
a situation.

Anxiety- uneasy feeling that occurs in response to a

threat.
School avoidance-child refuses to attend school due to
anxiety. Separation anxiety, school phobia, social phobia
Goals of treatment- help the child identify the source of
the anxiety, confronting and overcoming the anxiety.
Medication- antidepressants can be prescribed for severe
symptoms of anxiety or depression.

Morrison-Valfe 144

Emotional
Depression- symptoms often go unnoticed, lack interest in
activities they use to enjoy, pessimistic, hopeless about the
future

Somatoform disorder- signs or symptoms of an illness without

a physical trace or cause

Common in school age children

When the stress is relieved the child returns to a healthy level of
function.
Children need understanding and reassurance

Morrison Valfre 144

 Post traumatic stress disorder (PTSD)

Develops following an extremely traumatic
event that involves injury or threat to the child

Ex- experiencing a fire or witnessing a shooting.

The child feels intense helplessness, fear, and
horror.

Treatment- early recognition and and

emotionally supportive care.

Behavioral problems
When a child's conduct becomes inappropriate over
time a disruptive behavioral disorder is diagnosed.

Sometime behavioral disorder can be caused due to a

lack of neurotransmitters production in the brain.

Some disruptive behavioral disorders are attention

deficit/hyperactivity disorder, ADD, conduct disorder,
and oppositional defiant disorder.

Morrison-Valfe 146

 Attention Deficit/Hyperactivity Disorder

(ADHD)- difficulty paying attention, hyperactive,
listening, and easily distracted.

Signs and symptoms- fidgeting, difficulty

waiting for turns, interrupting, restlessness,
disregarding consequence of behavior, difficulty
playing quietly, losses things necessary for task
and activities at school or home, and engages in
physically dangerous activities.

Many subgroups within ADHD. (learning

disabilities, without hyperactivity, with speech
disorders, psychiatric disorders, disorders of
brain function)
Morrison Valfre 144

Diagnosed

1. A disturbance of at least 6 months which at

least eight of the followings are present.

Fidgeting, inability to sit still, excessive talking,

difficulty waiting turns, interrupting, disregarding
consequences of behavior, easily distracted by
outside stimuli, difficulty playing quietly,
interrupts and intrudes on others, and engages in
dangerous physical activity (Morrison Valfre 147 table
13-4)

2. Onset before the age of seven

Does not meet the criteria for pervasive
developmental disorder
Morrison Valfre 147

 Attention Deficit Disorder

Similar to ADHD
Children have difficulty paying attention but are
not significantly hyperactive or impulsive.

Treatment
Families are educated about the problem, and many
children receive special education. Child can also receive
drag therapy. Drug therapy includes

Long acting stimulants

lisdexamfetamine(Vyvanse) 30mg/day nursing implications
monitor mental status and growth rate. side effects pounding
HR, low BP, nausea

Nonstimulants- Ato,oxetine(Stattera) Take does in morning,

aviod OTC drugs, side effects nausea, dry mouth, dizziness

Antidepressants- Imipramine (Tofranil), may cause dry

mouth, blurred vision, constipation. Nursing implications
encourage client to drink a lot of water, diet high in fiber.

Antipsychotics (not commonly used) ex. chlorpromazine

(Thorazine) 6-8 mg/kg.day side effects dry mouth, weight
gain, low BP
Morrison-Valfre 147

Conduct Disorder
Engage in aggressive actions towards other
people, refuse to follow societys rules and norms,
and violate the rights of others, low self esteem,
temper outburst.

For diagnosis these symptoms must last longer

than six months

Contributing factors: parental reject or neglect,

parent with a history of psychological illness,

Treatment focus on a stable environment,

neurological, educational, or psychiatric problems
are also treated.

Treatment
Based on childs age and severity of symptoms
Psychotherapy- congenital behavioral therapy
improve problem solving skills, anger
management, and impulse control.

No medications formally approved but variety of

drugs used to treat some of its negative
symptoms.

Stimulants
Antidepressants
Morrison-Valfre 147 & ATI

Oppositional Defiant Disorder

ODD disorder is a reoccurring pattern of
disobedient, hostile behavior toward authority
figures
Children with this disorder lose there tempers,
argue with adults, deliberately annoy other people,
refuse to compromise, blame others for their
miserable behaviors and always test their limits.
Treatment includes family therapy that stresses
the limit setting and consistency.
Morrison-Valfre 148

Eating/Elimination
disorders
Children who fail to eat adequately.
Weight loss or failure to gain weight for 1 month for a child
with no GI problems

Ex- pica (eating non food items, paint, hair) anorexia,

bulimia, obesity.

Treatment- ruling out physical problem, teaching parents

feeding techniques, monitoring child's weight, family
therapy.

Rumination disorder- uncommon, infant regurgitates and

rechews food. 3-12 months may cause malnutrition.

Morrison-Valfre 149

 Anorexia nervosa- refusal to eat to keep body weight

at minimum (age 13-14, 17-18). Overly cooperative,
goal oriented,

Bulimia- cycle of binge eating followed by purging.(17)

Obesity- body weight over 20%
enuresis- primary nocturnal(bed wetting at
night),diurnal enuresis (day time wetting) secondary
(bladder trained child becomes incontinent

Encopresis- voluntary passage of feces in

inappropriate places ( over 4 yrs.)

Chemical dependency
Teens who become chemically dependent
(psychologically and physically requires a drug)

Four general stages: experimentation, active,

seeking, preoccupation, burnout.
s/s- change in habit, mood, personality (rebellious)
Treatment- replace the use of chemicals with more
effective coping skills. Anonymous support groups
Few teens seek treatment. Prevention and early
recognition remain the most effective for coping with
substance abuse

Sexuality disorder
Experiment with various sexual attitudes,
outlooks, and behaviors.

Gender identity disorder- common discomfort

with their assigns gender.

Therauptic- may request hormonal therapy,

surgery, or other procedures that may produce
characteristics of desired gender. Medical and
mental health therapies to relieve stress.

Mental retardation
Children who function significantly below the
average intellectual level for their age group and
limited in their abilities to function.

Score lower than 70 on IQ test

Fetal alcohol syndrome is leading cause
Heredity and environmental related factors
Therapeutic- meeting the childs basic needs,
providing and safe environment
Morrison-Valfre 150

Learning disorder
A child with normal intelligence falls below the
result of other children in the same age and
grade group.

Develop low self esteem, discouraged, drop out.

Dyslexia (learning disorder)

Pervasive developmental
disorders
Difficulty with social interaction, communication, and learning
skills

Not a disease but a syndrome of associated behaviors

Autism- disorder of communication and ability to interact with
others, use people like objects, abnormal speech

Cognitive and language development delayed

Observed before the age of 3
Therapeutic- parents, child, and treatment team work
together for each small gain in function, provide opportunities
Morrison-Valfre 151, ATI 243

 Children with schizophrenia

Develops during late adolescents
Signs and symptoms
Bizarre movements, alternating periods of
hypoactivity and hyperactivity, inappropriate
emotions and language, distorted sense of time
Early recognition is important because
schizophrenia is often a long term disorder.
Morrison-Valfre 151

Therapeutic Actions
Work with child to adopt a realistic view of their bodies and
improve overall self esteem. Support groups for eating
disorders and substance abuse, safety at home and school

Nursing care- initial assessment data - mothers

pregnancy and birth history, sleep eating and elimination
patterns, current medications, peer and family
relationships
Client outcomes- achieves maximal level of physical,
cognitive, and social development, verbalizes improved
mood, realistic goals
ATI-247

What you know?!?

1. A school age child is being evaluated for ADHD. The nurse should
expect to find which of the following in this child
a. inability to maintain eye contact
b. Easily distracted
c. Anxiety about separation from parent
d. Self- mutation
2. A nurse is observing an adolescent for clinical findings of conduct
disorder. The nurse should expect to observe which of the following?
(select all that apply)
A. Hostility
B. Frequent lying
C. Easy distraction
D. Activates that break the law
E. Careless mistakes
F. Cruelty to neighborhood pets
G. Poor eye contact with others