Time Specific objectives Content Teaching learning Evaluation

activities
CHILDHOOD AND ADOLESCENT DISORDERS ARE
CLASSIFIED UNDER:
5 min. To classify the 1. F80-F89:- Disorders of psychological Teacher classifies the Classify the childhood
childhood and development. childhood and adolescent and adolescent
adolescent disorders. a. F80 Specific developmental disorders of disorders using blackboard disorders.
speech and language. and lecture method.
b. F81 Specific developmental disorders of
scholastic skills.
c. F82 Specific developmental disorder of motor
function.
d. F84 Pervasive developmental disorders.
2. F90-F98:- Behavioral and emotional disorders
with onset usually occur in childhood and
adolescence.
a. F90 Hyperkinetic disorders.
b. F91 Conduct disorders.
c. F93 Emotional disorders with onset specific
to childhood
i. F93.0 Separation anxiety disorder of childhood
ii. F93.1 Phobic anxiety disorder of childhood
iii. F93.2 Social anxiety disorder of childhood
iv. F93.3 Sibling rivalry disorder.
d. F94 Disorders of social functioning with onset
specific to childhood and adolescence
i. F94.0 Elective mutism.
e. F95 Tic disorders.
f. F98 Other behavioural and emotional
disorders with onset usually occurring in
childhood and adolescence
i. F98.0 Nonorganic enuresis
ii. F98.1 Nonorganic encopresis
iii. F98.2 Feeding disorder of infancy and childhood
iv. F98.3 Pica of infancy and childhood
v. F98.4 Stereotyped movement disorders
vi. F98.5 Stuttering [stammering].
 vii. F98.6 Cluttering
viii. F98.8 Other specified behavioural and
emotional disorders with onset usually
occurring in childhood and adolescence.

F80 SPECIFIC DEVELOPMENTAL DISORDERS OF SPEECH

AND LANGUAGE:
5 min. To explain the specific These are disorders in which normal patterns of Teacher explains the Explain the specific
developmental language acquisition are disturbed from the early specific developmental developmental
disorders of speech stages of development. The conditions are not directly disorders of speech and disorders of speech
and language. attributable to neurological or speech mechanism language using lecture and language.
abnormalities, sensory impairments, mental method.
retardation, or environmental factors. It includes
developmental language disorder or dysphasia,
developmental articulation disorder or phonological
disorder or dyslalia, expressive language disorder,
receptive language disorder and other developmental
disorders of speech and language.

F81 SPECIFIC DEVELOPMENTAL DISORDERS OF

SCHOLASTIC SKILLS:
5 min. To explain the specific These are disorders in which the normal patterns of Teacher explains the Explain the specific
developmental Skill acquisitions are disturbed from the early stages of specific developmental developmental
disorders of scholastic development. They are not simply a consequence of a disorders of scholastic disorders of scholastic
skills. lack of opportunity to learn, nor are they due to any skills using blackboard and skills.
form of acquired brain trauma or disease. Rather, the lecture method.
disorders are thought to stem from abnormalities in
cognitive processing that derive largely from some type
of biological dysfunction. Specific developmental
disorders of scholastic skills are divided further into
specific reading disorder, specific spelling disorder and
specific arithmetic disorder.
F81.0 Specific reading disorders (dyslexia) is
characterized by a slow acquisition of reading skills,
slow reading speed, impaired comprehension, word
omissions and distortions and letter reversals.
F81.1 Specific spelling disorder is significant
impairment in development of spelling skills in the
 absence of a history of specific reading disorder. The
ability to spell orally and to write out words correctly
are both affected.
F81.3 Specific arithmetic disorder involves deficit in
basic computational skills of addition, subtraction,
multiplication and division.

F82 SPECIFIC DEVELOPMENTAL DISORDER OF MOTOR

FUNCTION:
5 min. To explain the specific Children with this disorder have delayed motor Teacher explains the Explain the
developmental development, which is below the expected level on the specific developmental developmental
disorder of motor basis of their age and general intelligence. The main disorder of motor disorder of motor
function. feature of this disorder is a serious impairment in the function using lecture function.
development of motor coordination, which results in method.
clumsiness in school work or play.

F84 PERVASIVE DEVELOPMENTAL DISORDERS:

20 min. To explain the The term Pervasive Developmental Disorder Teacher explains about What all is covered
pervasive (PDD) refers to a group of disorders characterized by the pervasive under pervasive
developmental abnormalities in communication and social interaction developmental disorders developmental
disorders. and by restricted repetitive activities and interests. using blackboard and disorders?
These abnormalities occur in a wide range of situations, lecture method.
usually development is abnormal from infancy and
most cases are manifest before the age of 5 years. PDD
includes childhood autism, atypical autism, Rett's
Syndrome, Asperger's syndrome, childhood
disintegrative disorder, and other pervasive
developmental disorders.

F84.0 Childhood autism:

A pervasive developmental disorder defined by the
presence of abnormal and/or impaired development
that is manifest before the age of 3 years, and by the
characteristic type of abnormal functioning in all three
areas of social interaction, communication, and
restricted, repetitive behaviour. The disorder occurs in
boys three to four times more often than in girls.
Etiology:
 Genetic factors: the higher concordance in
monozygotic than dizygotic twins suggests a
genetic factor.
 Neurological factors: abnormalities in brain
structures or functions have been correlated with
autistic disorder. Perinatal factors during
gestation, maternal bleeding after the first
trimester and meconium in the amniotic fluid
have been reported in the histories of autistic
children.
Symptoms:
1. Failure to form interpersonal relationships,
characterized by unresponsiveness to people; lack
of eye contact and facial responsiveness. In early
childhood, there is a failure to develop cooperative
play and friendships.
2. Impairment in communication (verbal and
nonverbal) characterized by absence of language.
3. Bizarre responses to the environment,
characterized by resistance or extreme behavioural
reactions to minor occurrences.
4. Extreme fascination for objects that move (e.g.,
fans, trains).
5. Stereotyped body movements (e.g., hand flicking
or twisting, spinning, head banging, complex
whole-body movements).
Treatment:
1. Pharmacotherapy: Some drugs that have been
used are resperidone, serotonin specific
reuptake inhibitors, clomipramine and lithium.
Antiepileptic medication is used for generalized
seizures.
2. Behavioural methods: such as special schooling,
counseling and supportive therapy, home care
to assist the behavioural changes and special
education programs that are highly structured
 focus on developing social skills, speech,
language, self care and job skills.
Common Nursing Diagnoses and Interventions:
 Risk for injury
Goals/Objectives:
Short-term Goal
Client will demonstrate alternative behaviour in
response to anxiety within specified time.
Long-term Goal
Client will not inflict harm on self.
Interventions with Selected Rationales:
1. Intervene to protect child when self-mutilate
behaviours, such as head banging or other hysterical
behaviours, become evident. The nurse is responsible
for ensuring client safety.
2. A helmet may be used to protect against head
banging, hand mitts to prevent hair pulling, and
appropriate padding to protect extremities from injury
during hysterical movements.
3. Try to determine if self-mutilate behaviours occur in
response to increasing anxiety and, if so, to what the
anxiety may be attributed. Mutilate behaviours may be
averted if the cause can be determined.
4. Work on one-to-one basis with child to establish
trust.
5. Offer self to child during times of increasing anxiety,
in order to decrease need for self-mutilative behaviours
and provide feelings of security.
 Impaired social interaction:
Goals/Objectives:
Short-term Goal
Client will demonstrate trust in one caregiver within
specified time.
Long-term Goal
Client will initiate social interactions (physical, verbal,
nonverbal) with caregiver by discharge from treatment.
Interventions with Selected Rationales:
1. Function in a one-to-one relationship with child.
Consistency of staff–client interaction enhances the
establishment of trust.
2. Provide child with familiar objects (favorite toys,
blanket). These items will offer security during times
when child feels distressed.
3. Convey a manner of warmth, acceptance, and
availability as client attempts to fulfill basic needs.
These characteristics enhance establishment and
maintenance of a trusting relationship.
4. Go slowly. Do not force interactions. Begin with
positive reinforcement for eye contact. Gradually
introduce touch, smiling, hugging. The autistic client
may feel threatened by an onslaught of stimuli to which
he or she is unaccustomed.
 Impaired verbal communication
Goals/Objectives:
Short-term Goal
Client will establish trust with one caregiver by
specified time
Long-term Goal
Client will have established a means for
communicating.
Interventions with Selected Rationales
1. Maintain consistency in assignment of caregivers.
Consistency facilitates trust and enhances caregiver’s
ability to understand child’s attempts to communicate.
2. Anticipate and fulfill client’s needs until satisfactory
communication patterns are established. Anticipating
needs helps to minimize frustration while child is
learning communication skills.
3. Use “en face” approach (face-to-face, eye-to-eye) to
convey correct nonverbal expressions by example. Eye
contact expresses genuine interest in, and respect for,
the individual.
  Disturbed personal identity
Goals/Objectives:
Short-term Goal
Client will name own body parts and body parts of
caregiver within specified time.
Long-term Goal
Client will develop ego identity.
Interventions with Selected Rationales:
1. Function in a one-to-one relationship with child.
Consistency of staff–client interaction enhances the
establishment of trust.
2. Assist child to recognize separateness during self-
care activities, such as dressing and feeding. These
activities increase child’s awareness of self as separate
from others.
3. Point out and assist child in naming own body parts.
This activity may increase child’s awareness of self as
separate from others.
4. Gradually increase amount of physical contact, using
touch to point out differences between client and
nurse. Be cautious with touch until trust is established,
because this gesture may be interpreted by client as
threatening.
5. Use mirrors and drawings or pictures of child to
reinforce child’s learning of body parts and boundaries.

F84.1 Atypical autism:

A pervasive developmental disorder that differs from
autism in terms of either age of onset or failure to fulfill
diagnostic criteria i.e. disturbance in reciprocal social
interactions, communication and restrictive
stereotyped behavior. Atypical autism is seen in
profoundly retarded individuals.

F84.2 Rett's syndrome:

Typically, normal or near-normal early development is
followed by partial or complete loss of acquired hand

15 min. To discuss Hyperkinetic
disorders as per ICD.
skills and of speech, together with deceleration in head
growth, usually with an onset between 7 and 24
months of age. Hand-wringing stereotypes,
hyperventilation and loss of purposive hand
movements are particularly characteristic. Severe
mental handicap invariably results. Fits frequently
develop during early or middle childhood.
F84.5 Asperger’s syndrome:
The condition is characterized by severe and sustained
abnormalities of social behaviour similar to those of
childhood autism with stereotyped and repetitive
activities and motor mannerisms such as hand and
finger-twisting or whole body movements. It differs
from autism in that there is no general delay or
retardation of cognitive development or language.
F90 HYPERKINETIC DISORDERS:
Hyperkinetic disorder (Attention-Deficit Hyperactivity Teacher discusses about What are the sign and
Disorder or ADHD in DSMIV) is a persistent pattern of hyperkinetic disorders symptoms of
inattention and or hyperactivity more frequent and using lecture method. hyperkinetic disorders?
severe than is typical of children at a similar level of
development. The disorder is frequently not diagnosed
until the child begins school because, prior to that time,
childhood behaviour is much more variable than that of
older children. ADHD is 4 to 9 times more common in
boys than in girls and may occur in as many as 3% to 7%
of school-age children. The course can be chronic,
persisting into adulthood.
Predisposing Factors:
1. Physiological:
a. Genetics: a number of studies have indicated that
hereditary factors may be implicated in the
predisposition to ADHD. Siblings of hyperactive
children are more likely than normal children to
have the disorder.
b. Biochemical: abnormal levels of the
neurotransmitters dopamine, nor epinephrine, and
 possibly serotonin have been suggested as a
causative factor.
c. Prenatal, perinatal, and postnatal factors.
Maternal smoking during pregnancy has been
linked to ADHD in offspring. Intrauterine exposure
to toxic substances, including alcohol, can produce
effects on behaviour. Premature birth, fetal
distress, precipitated or prolonged labor, and
perinatal asphyxia have also been implicated.
Postnatal factors include cerebral palsy, epilepsy,
And other central nervous system abnormalities
resulting from trauma, infections, or other
neurological disorders.
2. Environmental influences. Disorganized or chaotic
environments or a disruption in family equilibrium
may predispose some individuals to adhd. A high
degree of psychosocial stress, maternal mental
disorder, paternal criminality, low socioeconomic
status, poverty, growing up in an institution, and
unstable foster care are factors that have been
implicated.
Symptoms:
1. Difficulties in performing age-appropriate tasks.
2. Highly distractible.
3. Extremely limited attention span.
4. Shifts from one uncompleted activity to another.
5. Impulsivity, or deficit in inhibitory control, is
common.
6. Difficulty forming satisfactory interpersonal
relationships.
7. Disruptive and intrusive behaviours inhibit
acceptable social interaction.
8. Difficulty complying with social norms.
9. Some children with ADHD are very aggressive or
oppositional. Others exhibit more regressive and
immature behaviours.
10. Low frustration tolerance and outbursts of temper
are common.
11. Boundless energy, exhibiting excessive levels of
activity, restlessness.
12. Often described as “perpetual motion machines,”
continuously running, jumping, wiggling, or squirming.
Diagnosis
• Detailed prenatal history and early developmental
history.
• Direct observation, teacher's school report (Often the
most reliable), and parent’s report.
Treatment
Pharmacotherapy
• CNS stimulants: Dextroamphetamine,
methylphenidate, pemoline
• Tricyclic antidepressants
• Antipsychotics
 psychological treatment:
-family therapy
-behaviour therapy
-Head on confrontation avoided.
- Simple instruction at a time
-Rewarded for following instructions.
-Brief study periods with feedbacks.
Common Nursing Diagnoses and Interventions :
● Risk for self-directed or other-directed violence
Goals/Objectives:
Short-term Goals
1. Client will seek out staff at any time if thoughts of
harming self or others should occur.
2. Client will not harm self or others.
Long-term Goal
Client will not harm self or others.
Interventions with Selected Rationales:
1. Observe client’s behaviour frequently. Do this
through routine activities and interactions to avoid
appearing watchful and suspicious. Clients at high risk
for violence require close observation to prevent harm
to self or others.
2. Observe for suicidal behaviours: verbal statements.
Ask, “Do you plan to kill yourself?” and “How do you
plan to do it?” Direct, closed-ended questions are
appropriate in this instance. The client who has a
usable plan is at higher risk than one who does not.
4. Help client to recognize when anger occurs and to
accept those feelings as his or her own. Have client
keep an “anger notebook,” in which a record of anger
experienced on a 24-hour basis is kept. Information
regarding source of anger, behavioural response, and
client’s perception of the situation should also be
noted. Discuss entries with client, suggesting
alternative behavioural responses for those identified.
● Impaired social interaction
Goals/Objectives:
Short-term Goal
Client will interact in age-appropriate manner with
nurse in one-to-one relationship within 1 week.
Long-term Goal
Client will be able to interact with staff and peers, by
the time of discharge from treatment, with no
indication of discomfort.
Interventions with Selected Rationales:
1. Develop trusting relationship with client. Be honest;
keep all promises; convey acceptance of the person,
separate from unacceptable behaviours (“It is not you,
but your behaviour, that is unacceptable.”) Acceptance
of client increases his or her feelings of self-worth.
2. Offer to remain with client during initial interactions
with others. Presence of a trusted individual provides a
feeling of security.
3. Provide constructive criticism and positive
reinforcement for client’s efforts. Positive feedback
enhances self-esteem and encourages repetition of
desirable behaviours.
4. Confront client and withdraw attention when
interactions with others are manipulative or
exploitative. Attention to the unacceptable behaviour
 may reinforce it.

F91 CONDUCT DISORDERS:

15 min. To discuss about Conduct disorders are characterized by a persistent and Teacher discusses about What is the nursing
conduct disorders. significant pattern of conduct in which the basic rights conduct disorders using management of
of others are violated or rules of society are not black board. conduct disorders?
followed. The diagnosis is only made when the conduct
is far in excess of the routine mischief of children and
adolescents. The onset occurs much before 18 years of
age, usually even before puberty. The disorder is much
more (about 5to10 times) common in boys.
Etiology:
 Genetic factors: Studies with monozygotic and
dizygotic twins as well as with non-twin siblings
have revealed a significantly higher number of
conduct disorders among those whose family
members are affected with the disorder (Baum,
1989).Alcoholism and personality disorder in the
father is reported to be strongly associated with
conduct disorders.
 Biochemical factors: Various studies have reported
a possible correlation between elevated plasma
levels of testosterone and aggressive behaviors.
 Organic factors: Children with brain damage and
epilepsy are more prone to conduct disorders.
 Psychosocial factors:
• Parental rejection.
• Inconsistent management with harsh discipline.
• Frequent shifting of parental figures.
• Large family size.
• Absent father.
• Parents with antisocial personality disorder or alcohol
dependence.
• Parental permissiveness.
• Marital conflict and divorce in parents.
• Associations with delinquent subgroups.
• Inadequate/inappropriate communication patterns in
the family.
Symptoms:
1. Uses physical aggression in the violation of the rights
of others.
2. Stealing, fighting, lying, and truancy are common
problems.
3. There is an absence of feelings of guilt or remorse.
4. The use of tobacco, liquor, or non prescribed drugs,
as well as the participation in sexual activities, occurs
earlier than the peer group’s expected age.
5. Projection is a common defense mechanism.
6. Low self-esteem is manifested by a “tough guy”
image. Often threatens and intimidates others.
7. Characteristics include poor frustration tolerance,
irritability, and frequent temper outbursts.
8. Symptoms of anxiety and depression are not
uncommon.
9. Level of academic achievement may be low in
relation to age and IQ.
10. Manifestations associated with ADHD (e.g.,
attention difficulties, impulsiveness, and hyperactivity)
are very common in children with conduct disorder.
Treatment:
 Children with conduct disorder who are living in
abusive homes may be placed into others
homes.
 If abuse is not present, behavioural modification
therapy or talk therapy to help teach him or her
ways to adapt to feelings
 Family therapy
 Cognitive therapy.
 Drug treatment may be indicated in the
presence of epilepsy (anticonvulsants),
hyperactivity (Stimulant medication), impulse
control disorder and episodic aggressive
behavior (lithium, carbamazepine) and
psychotic symptoms (antipsychotics).
Common Nursing Diagnoses and Interventions :
● Risk for self-directed or other-directed violence
Goals/Objectives:
Short-term Goals
1. Client will seek out staff at any time if thoughts of
harming self or others should occur.
2. Client will not harm self or others.
Long-term Goal
Client will not harm self or others.
Interventions with Selected Rationales:
1. Observe client’s behaviour frequently. Do this
through routine activities and interactions to avoid
appearing watchful and suspicious. Clients at high risk
for violence require close observation to prevent harm
to self or others.
2. Observe for suicidal behaviours: verbal statements.
Ask, “Do you plan to kill yourself?” and “How do you
plan to do it?” Direct, closed-ended questions are
appropriate in this instance. The client who has a
usable plan is at higher risk than one who does not.
• Low self-esteem
Goals/Objectives:
Short-term Goal
Client will independently direct own care and activities
of daily living within 1 week.
Long-term Goal
By time of discharge from treatment, client will exhibit
increased feelings of self-worth as evidenced by verbal
expression of positive aspects about self, past
accomplishments, and future prospects.
Interventions with Selected Rationales:
1. Ensure that goals are realistic. It is important for
client to achieve something, so plan for activities in
which the possibility for success is likely. Success
enhances self-esteem.
2. Convey unconditional positive regard for client.
Communication of your acceptance of him or her as a
worthwhile human being increases self-esteem.
 3. Spend time with client, both on a one-to-one basis
and in group activities. This conveys to client that you
feel he or she is worth your time.
4. Assist client in identifying positive aspects of self and
in developing plans for changing the characteristics he
or she views as negative.

F93 EMOTIONAL DISORDERS WITH ONSET SPECIFIC TO

CHILDHOOD:
20 min. To explain in detail the  F93.0 Separation anxiety disorder of childhood: Teacher explains in detail What is the
emotional disorders In these disorders there is excessive anxiety concerning the emotional disorders predisposing factor
with onset specific to separation from those individuals to whom the child is with onset specific to associated with
childhood. attached. Onset may occur as early as preschool age, childhood using lecture separation anxiety.
rarely as late as adolescence, but always before age method.
18, and is more common in girls than in boys.
Predisposing Factors
1. Genetics: The results of studies indicate that a
greater number of children with relatives who
manifest anxiety problems develop anxiety
disorders themselves than do children with no
such family patterns.
2. Stressful Life Events: Studies indicate that
children who are predisposed to anxiety
disorders may be affected significantly by
stressful life events.
3. Family Influences: Several theories exist that
relate the development of separation anxiety to
the following dynamics within the family:
 An over attachment to the mother (primary
caregiver).
 Separation conflicts between parent and child.
 Enmeshment of members within a family.
 Overprotection of the child by the parents.
 Transfer of parents’ fears and anxieties to the
children through role modeling.
Clinical Features:
1. An unrealistic worry about possible harm befalling
major attachment figures or fears that they will
leave and not return.
2. Persistent reluctance or refusal to go to sleep,
without being near or next to a major attachment
figure.
3. Persistent inappropriate fear of being alone.
4. Repeated nightmares.
5. Repeated occurrence of physical symptoms e.g.
nausea, stomachache, headache, etc., on occasions
that involve separation from a major attachment
figure, such as leaving home to go to school.
6. Excessive tantrums, crying and apathy immediately
following separation from a major attachment
figure.
Treatment
1. Individual counseling: This is often useful to give
the child an opportunity to understand the basis
for anxiety and also to teach the child some
strategies for anxiety management.
2. Parental counseling: Parental counseling is
needed when there is evidence that they are
overanxious or over-protective about the child.
They should be persuaded to allow the child
more autonomy.
3. Family therapy: It is often needed when the
child's disorder appears to be related to the
family system. Treatment is designed to
promote healthy functioning of the family
system.
4. Pharmacological management: Anxiolytic drugs
such as diazepam may be needed occasionally
when anxiety is extremely severe, but they
should be used for short periods only.
Common Nursing Diagnoses and Interventions
● anxiety (severe)
Goals/Objectives:
Short-term Goal
Client will discuss fears of separation with trusted
individual.
Long-term Goal
Client will maintain anxiety at no higher than moderate
level in the face of events that formerly have
precipitated panic.
Interventions with Selected Rationales:
1. Establish an atmosphere of calmness, trust, and
genuine positive regard. Trust and unconditional
acceptance are necessary for satisfactory nurse–
client relationship. Calmness is important because
anxiety is easily transmitted from one person to
another.
2. Assure client of his or her safety and security.
Symptoms of panic anxiety are very frightening.
3. Explore child’s or adolescent’s fears of separating
from parents. Explore with parents possible fears
they may have of separation from child. Some
parents may have an underlying fear of separation
from child, of which they are unaware and which
they are unconsciously transferring to child.
4. Help parents and child initiate realistic goals.
 Impaired social interaction
Goals/Objectives:
Short-term Goal
Client will spend time with staff or other support
person, without presence of attachment figure, without
excessive anxiety.
Long-term Goal
Client will be able to spend time with others (without
presence of attachment figure) without excessive
anxiety.
Interventions with Selected Rationales:
1. Develop a trusting relationship with client. This is
the first step in helping client learn to interact
with others.
2. Attend groups with child and support efforts to
interact with others. Give positive feedback.
Presence of a trusted individual provides security
during times of distress. Positive feedback
encourages repetition.
3. Convey to the child the acceptability of his or her
not participating in group in the beginning.
Gradually encourage small contributions until
client is able to participate more fully. Small
successes will gradually increase self-confidence
and decrease self-consciousness, so that client will
feel less anxious in the group situation.
 F93.1 Phobic anxiety disorder of childhood:
Children, like adults, can develop fear that is focused on
a wide range of objects or situations. Some of these
fears (or phobias), for example agoraphobia, are not a
normal part of psychosocial development. Minor
phobic symptoms are common in childhood and usually
concern animals, insects, darkness, school and death.
The prevalence of more severe phobias varies with age.
In most cases, all fears decline by early teenage years.
 F93.2 Social anxiety disorder of childhood:
Children with this disorder show a persistent or
recurrent fear and avoidance of strangers which
interferes with social functioning. Treatment includes
simple behavioral methods, combined with reassurance
and support.
 F93.3 Sibling rivalry disorder:
Sibling rivalry/jealousy may be shown by marked
competition with siblings for the attention and
affection of parents, associated with unusual pattern of
negative feelings. Onset is during the months following
the birth of the younger sibling. In extreme cases there
is over-hostility, physical trauma towards and
 undermining of the sibling, regression with loss of
previously acquired skills (such as bowel and bladder
control) and a tendency to babyish behavior. There is
an increase in oppositional behavior with the parents,
temper tantrums, and dysphoria exhibited in the form
of anxiety, misery or social withdrawal.
Management:
• Parents should be helped to divide their attention
appropriately between the two children.
• Help the older child feel valued. At the same time,
limits should be set as appropriate.
• Preventive interventions such as preparing the child
mentally for the arrival of the sibling during pregnancy
itself, and involving him in the care of the sibling.

F94DISORDERS OF SOCIAL FUNCTIONING WITH ONSET

SPECIFIC TO CHILDHOOD AND
ADOLESCENCE:

10 min. To discuss disorders of  F94.0 Elective mutism: Teacher discusses about What is the
social functioning with The condition is characterized by a marked, emotionally the disorders of social management of the
onset specific to determined selectivity in speaking, such that the child functioning with onset child suffering from
childhood and demonstrates his or her language competence in some specific to childhood and elective mutism.
adolescence. situations but fails to speak in other (definable) adolescent using lecture
situations. Most frequently, the disorder is first method.
manifest in early childhood; it occurs with
approximately the same frequency in the two sexes,
and it is usual for the mutism to be associated with
marked personality features involving social anxiety,
withdrawal, sensitivity, or resistance. Typically, the
child speaks at home or with close friends and is mute
at school or with strangers, but other patterns
(including the converse) can occur.
Management:
Management includes a combination of behavioral and
family therapy techniques to promote communication
and the use of speech. Individual psychotherapy may
also help.

10 min. To explain in detail
about tic disorder.
Nursing management:
 It is crucial that a child with EM feel assured that
they will not be expected to speak.
 Do not try to make the child speak or ask why
they don’t speak. It will only increase anxiety
 As the child becomes more comfortable,
generally nonverbal communication will begin.
 Get down to the child’s level
 Find out something that really interests him or
her.
 Do not act “surprised” or make a big deal if the
child begins to speak
 Minimize eye contact and direct questioning
and phrase questions so the child can respond
nonverbally.
 Sometimes being silly and taking the pressure
off potentially stressful situation for the child
helps. Use a puppet or stuffed animal.
F95 TIC DISORDERS:
Tic is an abnormal involuntary movement, which occurs Teacher explains in detail What are the sign and
suddenly, repetitively, rapidly and is purposeless in about the tic disorders symptom of tic
nature. It is of two types: using OHP. disorder?
1. Motor tics, characterized by repetitive motor
movements.
2. Vocal tics, characterized by repetitive vocalizations.
Tic disorders can be either transient or chronic.
A special type of chronic tic disorder is Gilles de la
Tourette's syndrome or Tourette's disorder.
This is characterized by: multiple motor and vocal tics,
with duration of more than 1year. Onset is usually
before 11years of age and almost always before
21years of age. The disorder is more common (about 3
times) in males and has a prevalence rate of about 0.5
per 1000.
 Common simple motor tics include eye-blinking, neck-
jerking, shoulder-shrugging, and facial grimacing.
Common simple vocal tics include throat-clearing,
barking, sniffing, and hissing.
Treatment:
Pharmacotherapy is the preferred mode of treatment.
The drug of choice is haloperidol. In resistant cases or
in case of severe side effects, pimozide or clonidine can
be used. Behavior therapy may be used sometimes, as
an adjunct.
Common Nursing Diagnoses and Interventions:
 Risk for self-directed or other-directed
violence:
Goals/Objectives:
Short-term Goals
1. Client will seek out staff or support person at any
time if thoughts of harming self or others should occur.
2. Client will not harm self or others.
Long-term Goal
Client will not harm self or others.
Interventions with Selected Rationales:
1. Observe client’s behaviour frequently through
routine activities and interactions. Become aware
of behaviours that indicate a rise in agitation.
Stress commonly increases tic behaviours.
Recognition of behaviours that precede the onset
of aggression may provide the opportunity to
intervene before violence occurs.
2. Monitor for self-destructive behaviour and
impulses. A staff member may need to stay with
client to prevent self mutilation. Client safety is a
nursing priority.
3. Provide hand coverings and other restraints that
prevent client from self-mutilative behaviours.
Provide immediate external controls against self-
aggressive behaviours.
4. Redirect violent behaviour with physical outlets for
frustration. Excess energy is released through
 physical activities and a feeling of relaxation is
induced.
5. Administer medication as ordered by physician.

 Impaired social interaction

Goals/Objectives
Short-term Goal
Client will develop a one-to-one relationship with nurse
or support person within 1 week.
Long-term Goal
Client will be able to interact with staff and peers using
age appropriate, acceptable behaviours.
Interventions with Selected Rationales:
1. Develop a trusting relationship with client. Convey
acceptance of the person separate from the
unacceptable behaviour. Unconditional acceptance
increases feelings of self-worth.
2. Discuss with client which behaviours are and are not
acceptable. Describe in matter-of-fact manner the
consequences of unacceptable behaviour. Follow
through. Aversive reinforcement can alter undesirable
behaviours.
3. Provide group situations for client. Appropriate social
behaviour is often learned from the positive and
negative feedback of peers.
4. Act as a role model for client through appropriate
interactions with others. Role modelling of a respected
individual is one of the strongest forms of learning.

F98OTHER BEHAVIOURAL AND EMOTIONAL

DISORDERS WITH ONSET USUALLY OCCURRING IN
20 min. To discuss about other CHILDHOOD AND ADOLESCENCE: Teacher discusses about Explain about
behavioral and the behavioral and nonorganic enuresis.
emotional disorders  F98.0 Nonorganic enuresis: emotional disorders with
with onset usually It is a disorder characterized by involuntary voiding of onset usually occurring in
occurring in childhood urine by day and/ or night which is abnormal in relation childhood and adolescence
and adolescence. to the individual’s mental age and which is not a using chart and discussion
consequence of a lack of bladder control due to any method.
neurological disorder, epileptic attacks or any structural
abnormality of urinary tract.
Enuresis would not ordinarily be diagnosed in a child
under the age of 5 years or with a mental age less than
4 years.
In most cases, enuresis is primary (the child has never
attained bladder control). Sometimes it may be
secondary (enuresis starting after the child achieved
continence for a certain period of time).
Factors Associated with Enuresis:
• Faulty training: If toilet training is started too early,
and especially if coercive, produces confusion and
resentment rather than compliance. Also, if it is begun
too late, loss of bladder control can result.
• Emotional disturbances: Emotional problems or
conflicts can manifest in the form of disturbed bladder
control. These conflicts may be due to such factors like
dominating parents, harsh punishments and other
problems in the family, causing the child to feel
neglected and isolated. As the children grow older, they
become sensitive about their habit of bedwetting. They
develop feelings of inferiority and a sense of being
different from other children, which aggravates the
problem even further.
• Physical diseases and anatomic defects (e.g.
congenital anomalies of the genitourinary tract,
diseases involving the central nervous system) are
relatively rare causes for enuresis.
Management:
i. Exclude any physical basis for enuresis by history,
examination and if necessary, investigation of the
renal tract.
ii. Explain the parents and child about the
maturational basis of the problem and the
likelihood of spontaneous improvement.
iii. Fluid restriction after 6O' clock in the evening.
iv. Interruption of child's sleep and emptying bladder
in the toilet.
v. Medications: Tricyclic antidepressants like
imipramine or amitriptyline, 25-50mg at night.
The mechanism of action is unknown, but results
have demonstrated its effectiveness.
vi. The parents should be instructed not to blame the
child in any way. On no account should the child
be embarrassed or humiliated, which will only
serve to aggravate the problem.

 F98.1 Nonorganic encopresis:

It is the repeated voluntary or involuntary passage of
feces, usually of normal or near normal consistency, in
places not appropriate for that purpose in the
individual's socio-cultural setting.
Clinical manifestation:
i. Hard pellet like stool, blood streaked stool
ii. Stiff posture, standing at corner, little dancing.
iii. Red face, hiding behind furniture
iv. Hide soiled underwear
v. Refusing to go to school
vi. Low self esteem
Management:
i. Family tensions regarding the symptoms must be
reduced and a non-punitive atmosphere must be
created. Parental guidance and family therapy
often is needed.
ii. Behavioral techniques e.g. star charts, in which the
child places a star on a chart for dry or continent
nights.
iii. Individual psychotherapy to gain the cooperation
and trust of the child.
Nursing management:
i. Thorough history
ii. Physical assessment
iii. Help child to sit toilet at routines intervals
iv. Diet management
v. Decrease milk product
vi. Administer drugs, enema etc
vii. Family counseling and education

 F98.2 Feeding disorder of infancy and

childhood:
A feeding disorder of varying manifestations, usually
specific to infancy and early childhood. It generally
involves refusal of food in the presence of an adequate
food supply and a reasonably competent care-giver,
and the absence of organic disease. There may or may
not be associated rumination (repeated regurgitation
without nausea or gastrointestinal illness).

 F98.3 Pica of infancy and childhood:

Persistent eating of non-nutritive substances (soil, paint
chippings, etc).
Etiology:
i. Boredom, anxiety, depression, stress,
nutritional deficiency.
ii. Familial and cultural factors, poor socio-
economic status.
Treatment :
Consists of common-sense precautions to keep the
child away from abnormal items of diet. Pica usually
diminishes as the child grows older.

 F98.4 Stereotyped movement disorders:

These disorders are characterized by voluntary,
repetitive, stereotyped, nonfunctional, often rhythmic
movements that do not form part of any recognized
psychiatric or neurological condition. The movements
include body rocking, head rocking, hair plucking hair
twisting, finger flicking, mannerisms and hand flapping.
Stereotyped self-injurious behaviour includes repetitive
head-banging, face-slapping, eye-poking, and biting of
hands, lips or other body parts.
Management:
 Behavioral modification.
  Protection from injury.
 Parent education.
 Pharmacological.
i. Clomipramine
ii. Desmipramine
iii. Chlopromazine
iv. Haloperidol

 F98.5 Stuttering [stammering]:

It refers to frequent hesitation or pauses in speech
characterized by frequent repetition or prolongation of
sounds or syllables or words, disrupting rhythmic flow
of speech. Minor dysrhythmias of this type are quite
common as a transient phase in early childhood or as a
minor but persistent speech feature in later childhood
and adult life. They should be classified as a disorder
only if their severity is such as markedly to disturb the
fluency of speech. There may be associated movements
of the face and/or other parts of the body that coincide
in time with the repetitions, prolongations, or pauses in
speech flow. The usual treatment is speech therapy.

 F98.6 Cluttering:
Cluttering is a speech and communication disorder
characterized by a rapid rate of speech, erratic rhythm,
and poor syntax or grammar, making speech difficult to
understand.
Diagnosis:
A. Cluttering that is rapid rate (i.e. a rapid rate of
speech with breakdown in influence, but no
repetitions or hesitations) that is persistent or
recurrent and of a severity sufficient to give rise
to significantly reduced speech intelligibility.
B. Duration of at least three months.
Treatment:
The following are some treatment for cluttering :
i. Start treatment for encouraging the person to
 speak slower.
ii. Use visual aids such as a speedometer for
monitoring the rate of speech
iii. Begin with highly structured utterances.
iv. Have the person who clutters exaggerate stressed
syllables in words and articulate all syllables
v. Have the person who clutters listen to a
disorganized speech sample and then listen to a
sample of clear speech to increase awareness of
the correct production.

 F98.8 Other specified behavioral and

emotional disorders with onset usually
occurring in childhood and adolescence:
1. Attention deficit disorder without
hyperactivity.
2. (Excessive) masturbation.
3. Nail-biting
4. Nose-picking
5. Thumb-sucking.

ABNORMAL SEXUAL BEHAVIORS

10 min. To explain in detail the
abnormal sexual
behaviors.
Signs of sexual disturbances:
 The normative behaviours of childhood and Teacher explains in detail What are the signs of
adolescence are of concern when they are the abnormal sexual abnormal sexual
extensive or suggest preoccupation, or involve behaviors of childhood behaviours?
others in ways that are not consensual. using lecture and
 Sexually reactive children: Children who are pre discussion method.
pubescent boys and girls who have been
exposed to, or had contact with, inappropriate
sexual activities.
 Inappropriate sexual exposure: For children
aged below 11 we consider all forms of sexual
exposure in appropriate.
i. Preoccupied with sexual play, and should
engage in many other forms of play.
 ii. Engage in sexual play with much younger or
much older children.
iii. Have precious knowledge of sex beyond their
age.
iv. Sexual behaviours and interest should be similar
to those of others same-age children.
v. “Driven” to engage in sexual activities, and be
able to stop when told by a adult.

Abnormal sexual behaviour:

i. Negative effect on other children, physical or
emotional discomfort to themselves or other
due to sexual plays.
ii. Sexualize relationships, or see others as objects
for sexual interactions
iii. Experience fear, shame or guilt in their sexual
play.
iv. Engage in adult-type sexual activities with other
children
v. Direct sexual behaviours towards older
adolescents or adults
vi. Engage in sexual activities with animals
vii. Use sex to hurt others.
viii. Use bribery, threats, or force to engage other
children in sexual play.