Chapter 23: Children and Adolescents PDF

Summary

This document provides an overview of children and adolescents, focusing on separation anxiety disorder and intellectual developmental disorder. It details predisposing factors, nursing assessment, interventions, and outcomes. The document addresses family influences and common therapies for these conditions.

Full Transcript

**Chapter 23: Children and Adolescents** **Introduction**: - Some disorders in this chapter may not be recognized until later in life but symptoms appear in childhood - Often difficult to determine whether a child's behavior indicates emotional problems. - An emotional problem...

**Chapter 23: Children and Adolescents** **Introduction**: - Some disorders in this chapter may not be recognized until later in life but symptoms appear in childhood - Often difficult to determine whether a child's behavior indicates emotional problems. - An emotional problem is likely when behaviors: - Are not age appropriate, Deviate from cultural norms, Interfere with adaptive functioning **Separation anxiety disorder:** "**SS**, **S**eparation with **S**chool" - The essential feature of separation anxiety disorder is excessive fear or anxiety concerning separation from those to whom the individual is attached. - The anxiety exceeds that which is expected for the person's developmental level and interferes with social, academic, occupational, or other areas of functioning. - **Most commonly diagnosed age 5-6 y/o, upon starting school** - Predisposing factors: - Biological influences: genetics and temperament - Environmental influences: stressful life events - **Family influences: parental overprotection,** insecure parent-child attachment, and maternal depression - Tx: behavior therapy, **family therapy,** group therapy, psychopharmacology - **Nursing assessment:** - Onset may occur as early as preschool age, rarely as late as adolescence. - Child has difficulty separating most commonly from the mother or maternal-rolled parent - Occasionally, the separation reluctance is directed toward the father, siblings, or other significant individual to whom the child is attached. - Separation (or anticipation of separation) results in: - Tantrums, crying, screaming, complaints of physical problems, and clinging behaviors. - Associated common behaviors & symptoms: - Reluctance or refusal to attend school is especially common in adolescence. - Younger children may "shadow", or follow around the person from whom they are afraid to be separated - Worrying is common. - Nightmares may occur. - Specific phobias are not uncommon. - Fear of sleeping away from home is experienced. - Nursing dx: - Anxiety (severe) related to family history, temperament, overattachment to parent, negative role modeling - Ineffective coping related to unresolved separation conflicts and inadequate coping skills evidenced by numerous somatic complaints - Impaired social interaction related to reluctance to be away from attachment figure - Outcomes: - The client: - Is able to maintain anxiety at manageable level - Demonstrates adaptive coping strategies for dealing with anxiety when separation from attachment figure is anticipated - Interacts appropriately with others and spends time away from attachment figure to do so - Planning/implementation: - **Nursing care is aimed at:** - Helping the client maintain anxiety at a manageable level in the face of separation from a significant other - Assisting with development of more adaptive coping strategies - Developing trust and demonstrating the ability to interact appropriately with others - Evaluation requires reassessment of the behaviors for which the family sought treatment. - Both the client and the family members will have to change their behavior. **Intellectual developmental disorder (IDD):** - Characterized by deficits in general mental abilities, reasoning, problem solving, planning, abstract thinking, judgment, learning in both academic & from experience. - Onset prior to age 18 years - Dx features: - **General intellectual functioning** - Clinical assessment - Performance on IQ tests (not diagnostic). - **Adaptive functioning (diagnostic)** - Ability to adapt to requirements of activities of daily living and the expectations of their age and cultural group. - **Domains of adaptive functioning:** - **Conceptual skills:** language, reasoning - **Social skills:** communication and interacting with others - **Practical skills:** self care and managing every day tasks - Determining severity, **table 23-1**: - Severity Levels: Mild, Moderate, Severe, & Profound - **Mild (IQ 50-70)**: capable of independent living with assistance during times of stress - **Moderate (IQ 35-49)**: can perform some activities independently, may require supervision - **Severe (IQ 20-34)**: may be trained in elementary hygiene skills, requires complete supervision - **Profound (IQ \

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