Chapter 17: Disorders of Infancy, Childhood, and Adolescence Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

2 Mental Retardation Problems in adaptive functioning  Mild (85%)  Academic skills to grade 6  Minimum self-support  Moderate (10%)  Academic skills to grade 3  Provide self-care hygiene  Severe (3% to 4%)  Rudimentary communication  Simple skills  Profound (1% to 2%)  Sensory-motor problems

3 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Autism  Abnormalities of eating/sleeping  Stereotyped behaviors  Preoccupied with rituals/sameness  Lack of emotional reciprocity  Inappropriate affect  Intellectual limitations  Absent/poor language skills  Perceptual problems  Limited social skills

4 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Asperger’s Disorder  Sustained social impairment  Restricted, repetitive behaviors  No delays in development of language, cognitive skills

5 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Attention-Deficit/ Hyperactivity Disorder (ADHD)  Genetic factors likely  Motor hyperactivity  Attention deficit  Noisy  Impulsive  Labile  Low self-esteem  Learning disorder  Social problems

6 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Developmental Disorders  Learning  Coordination  Communication

7 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Separation Anxiety Disorder  Somatic complaints  Anxiety/fear  Nightmares  Social manifestations

8 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Tourette’s Disorder  Tic: Sudden rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization  Simple motor tics  Complex motor tics  Simple vocal tics  Complex vocal tics  Self consciousness, shame  Social discomfort, low self-esteem

9 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Conduct Disorder  Repetitive, persistent pattern of violating rights of others (bully, threaten, intimidate, fight, act cruelly, force sex)  High-risk behaviors  Little empathy  Misperceive others’ motives  Learning impairments  Impaired social figures

10 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Oppositional Defiant Disorder  Defiance  Disobedience  Hostility toward authority figures

11 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Other Problems Affecting Children and Adolescents  Suicide  Youth violence  Substance abuse  Depression  Bipolar disorder  Schizophrenia  Anxiety disorders

12 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Assessment  Developmental stage  Within context of family dynamics  Identified client?  Physical assessment  Family life  Activities of Daily Life (ADLs)

13 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Nursing Diagnosis Look carefully at:  Safety issues  Communication  Relationships  Family issues

14 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Outcome Identification Foci:  Promotion of normal growth and development  Improving dysfunction

15 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Planning  Involve client  Involve family  Involve treatment team

16 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Implementation  Support client and family through change process  Provide role model  Set consistent boundaries and limits  Expect testing behaviors  Maintain safety  Provide therapeutic activity

17 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Implementation, cont’d.  Behavior modification  Goal setting  ADLs  Impulse control  Relationships  Rewards for accomplishment  Chart for preschool and school age  Contracts for older children, teens; use increased privileges

18 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Nursing Interventions  Maintain safe environment.  Contraband  Suicidality  Aggressive behavior  Communicate respect.  Promote boundaries, expectations.  Set fair limits  Increase self-confidence, self-esteem.  Realistic praise  Maintain realistic, hopeful outlook.

19 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Other Treatment Modalities  Medications  Activity therapies