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Child and adolescent disorders

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Mental retardation

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Mental retardation

Mental retardation involves below-averageintellectual functioning (IQ below 70),accompanied by significant limitations in

adaptive functioning areas, such ascommunication skills, self-care, home living,social or interpersonal skills, use ofcommunity resources, self-direction, academic

skills, work, leisure, health, and safety.

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Degrees of retardation

Mild (IQ 50 to ---70)

Moderate (IQ 35 to ---50)

Severe (IQ 20 to ---35) Profound (IQ below 20)

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Signs & Symptoms

D decreased Cognitive & intellectual

functioning

D deficits in psychomotor skills D difficulties in performing self-care

activities

D degrees of neurologic impairment

D depressed or labile mood

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Treatment

1. BEHAVIOR MANGEMENT

2. ENVIRONMENTAL SUPERVISON

3. MONITORING OF CHILDS DEVELOPMENTALNEEDS & PROBLEMS

4. PROGRAMS THATMAXIMIZE SKILLS

5. FAMILY THERAPY

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Nursing Intervention

1. Determine a plan of care

2. Monitor childs developmental levels

3. Teach about natural & normal feelings of

emotions

4. Safety needs

5. Prevent self-injury

6. Behavior modification

7. KEY COMMUNICATION : brief, simple & consistent

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Autistic Disorder

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Autistic Disorder

Best known of these disorders

More prevalent in boys

Present by age 3

Child has little eye contact, few facial expressions,does not communicate verbally or with gestures,doesnt relate to peers or parents, lacks spontaneousenjoyment; apparent absence of mood and affect;

cannot engage in play or make-believe with toys

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Autistic Disorder

Hand-flapping, body-twisting, head-banging

Autism may improve, sometimes substantially,

as language and communication skills arelearned.

Traits persist into adulthood. Few attain

complete independence, marry, or have

children.

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Autistic Disorder

Most autistic children are mainstreamed in

school.

Medications may be used to target specific

behaviors but do not treat the autism.

Goals are to reduce behavioral symptoms and

promote learning, development, and language

skills.

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Treatment

1. Early intervention, special education &family support.

2. Drugs, Methylphenidate to reduceinattentiveness, impulsivity & overactivity.

3. Family counselling

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Nursing Intervention

1. Choose words carefully when speaking.

2. Provide emotional support to parents

3. Promote communication : close, face-to-

face contact with the child

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Retts Disorder

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Aspergers Disorder

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Aspergers Disorder

Same impaired social interaction and

restricted stereotyped movements as in

autism, but no language or cognitive delays;

rare

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Attention Deficit Hyperactivity

Disorder (ADHD)

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Attention Deficit Hyperactivity

Disorder (ADHD)

Marked by developmentally inappropriate

inattention, impulsiveness, and in some cases,

HYPERACTIVITY.

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Signs & Symptoms INATTENTION

Fails to close attention details

Has trouble sustaining attention in tasks

Not to listen when spoken directly

Fails to follow instructions

Trouble in organizing tasks

Reluctant to engage in tasks

HYPERACTIVITY-IMPULSIVITY

Fidgets with his hands or feet or squirms in his seat

Run abouts

Trouble in playing & engagaing in leisure activities

On the go

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Treatment

P Psychotherapy to reduce ADHDsymptoms

E Education

P Pharmacology, RITALIN

S - strengths

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Nursing Interventions

1. Trusting & accepting relationship

2. Verbalize emotions

3. Assess risk of injury

4. Safe & calm environment

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Conduct Disorder

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Conduct Disorder

Persistent antisocial behavior of children andadolescents that significantly impairs ability tofunction in social, academic, or occupational areas

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Signs & Symptoms

C Cheats D destroys property

O Obnoxious I - intimidates

N Nasty in speech & S Steals

& behavior

D Drug & alcohol use O onset of antisocial PD

U unpredictable behavior R - rages

C cruel to people D disrespectful

or animals

T truant E esteem low

D destroys property R reckless or risky

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Treatment

1. Psychotherapy

2. Drugs that can treat neurologic difficulties

3. Educational Strategies

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Nursing Intervention

1. Work to establish a trusting relationship

with the child.

2. Behavioral guidelines 3. Talk about making acceptable choices

4. Effective problem-solving skills

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Oppositional Defiant Disorder

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Oppositional Defiant Disorder

Enduring pattern of uncooperative, defiant,

and hostile behavior toward authority figures

that does not involve major antisocial

violations

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Signs & Symptoms

1. Loses TEMPER

2. often argues with adults

3. Often defies or refuses to comply with adults

requests 4. Annoys people deliberately

5. blames others for mistakes

6. Touchy or easily annoyed by others

7. Angry & resentful

8. Spiteful & vindictive

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Treatment & Nursing Intervention

FAMILY THERAPY

Convey acceptance

Discuss childs limits & consequences

Help address negative feelings

Stop plotting accept responsibility of own

behavior Role-playing problem solving skills

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Tourettes Disorder

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Tourettes Disorder

Multiple motor tics and one or more vocal

tics; vocal tics can be name-calling or

profanity; can persist into adulthood

Person is embarrassed and self-conscious, and

has significant impairment in academic, social,

occupational areas.

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Signs & Symptoms

Tics

eye blinking

Facial grimacing

Neck, head jerking

Neck stretching

Foot stamping

Body twisting & bending

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Treatment

1. Psychotherapy

2. Pharmacotherapy

Low dose anti-psychotics, PIMOZIDE, RESPERIDONE,

HALOPERIDOL

SSRIs, fluoxetine

Anti-HPN, clonidine

NURSING INTERVENTION: Develop childs TRUST; provide

quiet activities; Stay positive about himself

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Chronic Motor or Tic Disorder

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Chronic Motor or Tic Disorder

Has only vocal tic or only motor tics, not both,

as with Tourettes.

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Self-Awareness Issues

Recognize own beliefs about parenting and

how they differ from others.

Focus on patients strengths, not justproblems.

Try to have positive impact on child, even

when disability is severe.

Support parents

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Thank you!