Chapter 23: Children and Adolescents PDF

**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 \