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Chapter 33The Child with an Emotional or Behavioral ConditionObjectivesDifferentiate among the following terms: psychiatrist, psychoanalyst, clinical psychologist, and counselor. Discuss the impact of early childhood experience on a person’s adult life.Discuss the effect of childhood autism on growth and development.Objectives (cont.)Discuss behavioral therapy and how it is applied to obsessive-compulsive disorders and depression in children.List the symptoms of potential suicide in children and adolescents.Discuss immediate and long-range plans for suicidal patient.List four behaviors that may indicate substance abuse.Objectives (cont.)Name two programs for members of families of alcoholics.Discuss the problems facing children of alcoholics.List four symptoms of attention-deficit/ hyperactivity disorder.Describe techniques of helping children with attention-deficient/hyperactivity pare and contrast the characteristics of bulimia and anorexia nervosa.The Nurse’s RoleTo work effectively with the disturbed child, nurse must recognize behavior that is in normal rangeKeep accurate documentation of behaviors and note relationships or interactions with the patient and members of the familyMultidisciplinary ServicesNational Alliance for Mentally Ill (NAMI)Family Services Association of America, Inc.Tough LoveYouth Suicide, National CenterNursing TipsParents provide important assessment data about the child that the young child cannot provideThey are also important in bringing the child to therapyDiscrediting parents threatens the child and is not therapeuticHealth Care StaffBasic staffPsychiatristPsychologistClinical psychologistCounselorSocial workerPediatricianNurseTypes of InterventionsIndividualFamily therapyBehavior modificationMilieu therapyArt therapyPlay therapyRecreation therapyBibliotherapyOrigins of Emotional and Behavioral ConditionsDysfunctional families can have long-lasting impact on the child Failure to develop sense of trustExcessive fearsMisdirected angerFeelings of lack of control over themselves and their environmentMay feel negative about themselvesMay experience guilt and blame themselves when confronted with disappointment and failureOrganic Behavioral DisordersChildhood AutismMay be due to autosomal recessive inheritanceSigns and symptomsLack of pointing or gesturing at an early ageFailure to make eye contact/look at othersPoor attentionPoor response to nameRepetitive behaviors are significant signs of dysfunction by 1 year of ageRequires highly structured environmentUse one request at a timeObsessive-Compulsive Disorders in ChildrenInvolves a recurrent, persistent, repetitive thought that invades the conscious mind (obsession) or ritual movement or activity (not related to adapting to the environment) that assumes inordinate importance (compulsion)Obsessive-Compulsive Disorders in Children (cont.)May be related to depressionMay start as early as 4 years of age and progress to interfering with daily functioning until 10 years of age or olderNo impairment in cognitive functionGenetic originCan involve family problemsTreatment is behavior therapy and medicationEnvironmental or Biochemical Behavioral DisordersDepressionA prolonged behavioral change from baseline that interferes with school, family life, or age-specific activitiesDifficult to diagnose in childrenCan lead to substance abuse if left untreatedDepression (cont.)Young childrenSymptoms can includeHead bangingTruancyLyingStealingIf left untreated, can lead to substance abuse and/or suicideSchool-age childrenSymptoms can includeLoss of appetiteSleep problemsLethargySocial withdrawalSudden drop in gradesDepression (cont.)Nursing responsibilitiesRecognizing the signsInitiating referralsEducating parents and school personnel concerning the identification of children at riskTreatmentMedicationOutpatient counselingSuicideLeading cause of death in adolescence, after accidents and homicideCompleted suicides more common with boysAttempted suicides more common with girlsRisk of successful suicide increases whenThere is a plan of actionA means to carry out the planAn absence of obvious resources to turn to for helpLow self-esteem or frustrations turn hostilities inwardSuicide (cont.)Suicidal ideationThoughts of suicideSuicidal gesturesAn attempt at suicidal action that does not result in injurySuicidal attemptAn action that is seriously intended to cause deathCan be impulsive act or chronic behaviorSuicide (cont.)Nurse’s roleEducationPreventionIdentification of those children at riskPrompt referral for follow-up careNursing TipWhen an adolescent feels hopeless and talks about feeling useless or worthless, do not contradict what he or she is sayingInstead listen, indicate your understanding, and encourage the expression of feelingsSubstance AbuseIllegal use of drugs, alcohol, or tobacco for the purpose of achieving an altered state of consciousnessSubstances can beIngestedInjectedInhaled Substance Abuse (cont.)Four levels ExperimentationControlled useAbuseDependence PsychologicalPhysical Substance Abuse (cont.)Two types of dependencePsychological and physicalSubstances that are used/abusedAlcoholExperimentation has traditionally been accepted as a normal part of growing upCocaine (“crack”)Can be snorted, smoked, or injected into a veinCan cause antisocial behavior or life-threatening responseSubstance Abuse (cont.)Gateway substances (lead to abuse of stronger drugs)Common household products cause euphoria (high) and then CNS depressionCleaning fluidGlueLighter fluidPaintsShoe polishSubstance Abuse (cont.)Marijuana (hemp plant)Smoked or ingestedCauses the person to experienceLoss of inhibitionsEuphoriaLoss of coordination and directionSubstance Abuse (cont.)OpiatesHeroinUsers are at risk forHIVHepatitisLong-term therapy is requiredSubstance Abuse (cont.)Prevention and nursing goalsTeach parenting skills to expectant parentsDevelop positive self-image and feelings of self-worthProvide positive role modelsDevelop coping skills regarding substance abuseSubstance Abuse (cont.)Children of alcoholicsSupport groups availableAl-Anon (for adolescents)Alcoholics Anonymous (AA—for adults)Child confused by unpredictability of family lifeTheir needs are not being metMay take role of parentMay be isolated from peersRole models distorted or lackingChildren of AlcoholicsChildren of Alcoholics (cont.)CluesRefusal to talk about family lifePoor grades or overachievementUnusual need to pleaseFatiguePassive or acting-out behaviorMaturity beyond the child’s yearsAttention Deficit Hyperactivity Disorder (ADHD)An inappropriate degree of gross motor activity, impulsivity, and inattention in school or home setting that begins before age 7 years, lasts more than 6 months, and is not related to the existence of any other central nervous system illnessCharacterized by inattention, hyperactivity, impulsivity, and distractibilityMay be geneticAttention Deficit Hyperactivity Disorder (ADHD) (cont.)DSM-IV-TR lists criteria for ADHDMay have above-average intelligenceProblem may be Receptive languageExpressive languageInformation processingMemoryMotor coordinationOrientationBehavior Attention Deficit Hyperactivity Disorder (ADHD) (cont.)Screening tools can enable early interventionSuch as “Einstein Evaluation of School-Related Skills”May haveDyslexiaDysgraphiaProblem expressing themselvesAnorexia NervosaA form of self-starvation seen mostly in adolescent girlsAnorexia Nervosa (cont.)Criteria according to the DSM-IV-TRFailure to maintain the minimum normal weight for age and heightAn intense fear of gaining weightExcess influence of body weight on self-evaluationAmenorrheaAnorexia Nervosa (cont.)May be geneticCharacteristicsAverage to superior intelligenceOverachievers who expect to be perfect in all areasThreatened by their emerging sexualityObedientNonassertive and shyHave a low self-esteemAnorexia Nervosa (cont.)On physical examination may findDry skinAmenorrheaLanugo hair over the back and extremitiesCold intoleranceLow blood pressureAbdominal painConstipation Anorexia Nervosa (cont.)Adolescent experiencesFeelings of helplessnessLack of controlLow self-esteemDepression Socialization with peers diminishesMealtimes are a battlegroundBody image becomes increasingly disturbedLack of self-identityAnorexia Nervosa (cont.)TreatmentMay require hospitalizationElectrolyte imbalanceEstablish minimum restoration of nutrientsStabilize weightTherapyIndividual and familyMedicationsAnorexia Nervosa (cont.)PrognosisGaining weight while in hospital is not a good predictor of future successComplications includeGastritisCardiac arrhythmiasInflammation of the intestinesKidney problemsDeathBulimiaDSM-IV-TR lists characteristics asRecurrent episodes of uncontrolled binge eating followed by self-induced vomiting and the misuse of laxatives and/or diureticsFamily dysfunction usually present Mother-daughter relationship usually distant or strainedBulimia (cont.)Binge-purge cycle thought to be a coping mechanism for dealing with guilt, depression, and low self-esteemImpulsive behaviors also characteristic Persistent vomiting causes erosion of tooth enamelUse of laxatives and vomiting can cause electrolyte imbalanceBulimia (cont.)Nursing roleEducatePreventIdentifyRefer Minimizing the Impact of Behavioral Disorders in ChildrenOnce the source of the problem is identified, a combination of mental health interventions can be implemented or the child can be referred as neededEffect of the Illness on Growth and DevelopmentDuration and intensity of a stressful event and the child’s coping skills determine the impact on the growth and development processRequires a total family approach to careA knowledgeable, caring, understanding, and supportive nature is valuable for any nurse caring for children with behavioral disordersEffect of the Illness on SiblingsMost siblings of children with emotional disorders either suffer emotional scars or develop protective coping mechanisms to deal with their experiencesIf long-term, the siblings are at risk for developing low self-esteem and problems with their own peer relationshipsSibling RivalryA competition between siblings for the attention or love of parentsIs a normal part of growth and developmentCan cause guilt on the part of the sibling who is not illTeaches interactive social skills that will be used with friendsQuestion for Review What is the difference between the eating disorders of anorexia nervosa and bulimia?ReviewObjectivesKey TermsKey PointsOnline ResourcesReview Questions ................
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