1. Chapter 23
The Child

2. Attention-Deficit/Hyperactivity Disorder (ADHD)
Diagnosed when signs of inattention, hyperactivity, or both are displayed
Symptoms include:
Ignoring instructions and tasks
Disorganization
Fidgeting and squirming
Being easily provoked to anger

3. Diagnosis Must be present before age 7
Must be present in two or more settings
Must be clear evidence of clinically significant impairment in social, academic, or occupational functioning
Can only be diagnosed by matching behavior against DSM-IV-TR criteria

4. Etiology Dopamine hypothesis Genetic role Diet and food additives
Maternal use of stimulants and tobacco

5. Pharmacological Treatment
Psychostimulants
Ritalin most common
Side effects:
Insomnia, decreased appetite, abdominal pain, headaches, jitteriness, or tics
(continued)

6. Pharmacological Treatment
Strattera
Not controlled substance
Easier dosing
Side effects:
Liver toxicity
Suicidal ideation

7. Prognosis Many symptoms decrease with time May follow into adulthood
Many adults being diagnosed with ADHD

8. Reactive Depression Adjustment disorder with depressed mood
Short-lived
Occurs in response to specific experience

9. Major Depressive Disorder
One or more major depressive episodes lasting from seven to nine months without treatment

10. Major Depressive Disorder Symptoms
Client may:
Appear sad
Lose interest in previously enjoyed activities
Criticize self
Sleep poorly
Experience appetite changes
Feel hopeless
Display irritability/aggressive behavior
(continued)

11. Major Depressive Disorder Symptoms
Client may:
Appear indecisive
Lack energy
Neglect appearance
Experience psychotic symptoms
Auditory hallucinations
Experience anxiety and somatization

12. Suicide Completed suicide rare in children
Incidence of attempts peaks during mid-adolescent years
Mortality from suicide
Third leading cause of death in adolescents

13. Assess Serious family pathology as underlying cause Child abuse
Domestic violence
Sexual abuse
Eating disorders
Substance abuse

14. Dysthymia Depression that occurs on most days for most of the day
Interferes with normal psychosocial development
Affects self-image
Eventually, depressed mood becomes norm

15. Bipolar Disorder Episodes of mania alternating with depression
Manifests as intensive purposive behavior
Leads to self-harm
Begins in adolescence
May be seen in children
May be misdiagnosed as ADHD

16. Depression Relatively common in childhood 10 to 15 percent at any time
Early onset may lead to higher risk of mental disorder in adulthood

17. Causes of Depression
Children of depressed parents three times more likely to experience an episode
Research into hypothalamus and pituitary gland growth continues
Development of pessimistic attribution bias

18. Psychological Treatment of Depression
Self-control therapy may be useful
Research into other cognitive-behavioral therapies continues

19. Pharmacological Treatment of Depression
Tricyclic antidepressants not proven to work in children
SSRIs do seem to work
Currently very controversial
May increase suicidal ideation

20. Anxiety Disorders Separation anxiety disorder
Generalized anxiety disorder
Social phobia
Obsessive-compulsive disorder

21. Treatment of Anxiety Contingency management Desensitization
Cognitive-behavioral therapy
SSRIs
No benzodiazepines

22. Autism Three per 1,000 children over age 3
Profound lack of interest in social interactions
Resistance to interpersonal contact
Repetitive behaviors
E.g., rocking, spinning

23. Treatment Early, intensive education
Special education in highly structured environments
Haldol (haloperidol)
Newer neuroleptics
SSRIs

24. Asperger’s Syndrome
Combination of severe impairments in social interaction with highly repetitive patterns of interests and behaviors
Consistent inability to regulate social interactions
No specific neurological abnormalities

25. Oppositional Defiant Disorder
Consistently rejects adult authority
Loses temper
Argues with adults
Deliberately refuses to comply with requests or rules of adults
Blames others for own mistakes
Acts stubborn and tests limits

26. Conduct Disorder One of the most serious childhood disorders
Pattern of cruelty and disrespect
Capability of severe violence and murder
Incidence of 0.4 to 3.3 percent
(continued)

27. Conduct Disorder May become antisocial adult
Treatment includes psychosocial methods and psychoactive drugs

28. Assessment Presenting problem Health history School and social history
Developmental history
Psychiatric history
Physical assessment
Mental status exam

29. Nursing Diagnosis Anxiety Impaired social interaction
Ineffective coping
Risk for violence
Low self-esteem

30. Outcome Identification
Establish realistic and achievable goals
Take into account child’s developmental level and family situation

31. Planning/Interventions
Support and understanding essential
Two levels of intervention:
Family
Child
Teach coping skills
Improve self-esteem
(continued)

32. Planning/Interventions
Play therapy
Individual and family therapy
Psychopharmacology

33. Evaluation Child’s progress Family unit’s progress
Progress may be slow
Help family realistically view successes in increments
Family and child should mutually agree on successes and failures

34. Schools and Special-Needs Children
More than 5,000,000 children have a disability
Individuals with Disabilities Education Act (IDEA) mandates “appropriate” education for these children
Each child has individual education plan (IEP)
Reviewed and updated yearly