 Autism does have a genetic link; many children with
NEURODEVELOPMENTAL DISORDERS
INTRODUCTION
 Psychiatric disorders are not diagnosed as easily in
children as they are in adults. Children usually lack
the abstract cognitive abilities and verbal skills to
describe what is happening. Because they are
constantly changing and developing, children have
limited sense of a stable, normal self to allow them to
discriminate unusual or unwanted symptoms from
normal feelings and sensations.
 Intellectual disability is the correct diagnostic term
for what was once called mental retardation, a term
often used in a disparaging manner to bully or
ridicule individuals with impaired cognitive abilities.
The essential feature of intellectual disability is
below-average intellectual functioning (intelligence
quotient [1Q]<70) accompanied by significant
limitations in areas of adaptive functioning Such as
communication skills, self-care, home living, social
or interpersonal skills, use of community resources,
self-direction, academic skills, work, leisure, and
health and safety.
 Mood and behavior disturbances vary among people
with intellectual disabilities. Some people with
intellectual disability are passive and dependent;
others are aggressive and impulsive; and still others
may have minimal mood and behavior disturbances.
AUTISM SPECTRUM DISORDER
 Autism spectrum disorder (ASD) is the DSM-5
(Diagnostic and Statistical Manual of Mental
Disorders, fifth edition) diagnosis that includes
disorders previously categorized as different types of
a pervasive developmental disorder (PDD),
characterized by pervasive and usually severe
impairment of reciprocal social interaction skills,
communication deviance, and restricted stereotypical
behavioral patterns.
 ASD, formerly called autistic disorder, or just autism,
is almost five times more prevalent in boys than in
girls, and it is usually identified by 18 months and no
later than 3 years of age. The behaviors and
difficulties experienced vary along the continuum
from mild to severe. Children with ASD have
persistent deficits in communication and social
interaction accompanied by restricted, stereotyped
patterns of behavior and interests/activities.
 Eighty percent of cases of autism are early onset,
with developmental delays starting in infancy. The
other 20% of children with autism have seemingly
normal growth and development until 2 or 3 years of
age, when developmental regression or loss of
abilities begins. They stop talking and relating to
parents and begin to demonstrate behaviors
previously described.
autism have a relative with autism or autistic traits.
Controversy continues about whether measles,
mumps, and rubella (MMR) vaccinations contribute
to the development of late- or regressive-onset
autism.
 Autism tends to improve, in some cases substantially,
as children start to acquire and use language to
communicate with others. If behavior deteriorates in
adolescence, it may reflect the effects of hormonal
changes or the difficulty meeting increasingly
complex social demands. Autistic traits persist into
adulthood, and most people with autism remain
dependent to some degree on others.
 Until the mid-1970s, children with autism were
usually treated in segregated, specialty outpatient, or
school programs. Those with more severe behaviors
were referred to residential programs. Since then,
most residential programs have been closed; children
with autism are being "mainstreamed" into local
school programs whenever possible.
 Pharmacologic treatment with antipsychotics, such as
haloperidol (Haldol), risperidone (Risperdal),
aripiprazole (Abilify), or combinations of
antipsychotic medications, may be effective for
specific target symptoms such as temper tantrums,
aggressive- ness, self-injury, hyperactivity, and
stereotyped behaviors. Other medications, such as
naltrexone (Re Via), clomipramine (Anafranil),
clonidine (Catapres), and stimulants to diminish self-
injury and hyperactive and obsessive behaviors, have
had varied but unremarkable results. there are no
medications approved for the treatment of ASD itself.
Behaviors Common with ASD
 Not responding to own name by 1 year (e.g., appears
not to hear)
 Doesn't show interest by pointing to objects or people
by 14 months of age
 Doesn't play pretend games by 18 months of age
 Avoids eye contact
 Prefers to be alone
 Delayed speech and language skills Obsessive
interests (e.g., gets stuck on an idea)
 Upset by minor changes in routine
 Repeats words or phrases over and over
 Flaps hands, or rocks or spins in a circle; answers are
unrelated to questions
 Unusual reactions to sounds, smells, or other sensory
experiences
Related Disorders
Tic Disorders
 A tic is a sudden, rapid, recurrent, nonrhythmic,
stereoyped motor movement or vocalization. Tics
can be suppressed but not indefinitely. Stress
exacerbates tics, which diminish during sleep and
 when the person is engaged in an absorbing activity.
Common simple motor tics include blinking, jerking
the neck, shrugging the shoulders, grimacing, and
coughing. Common simple vocal tics include
clearing the throat, grunting, sniffing, snorting, and
barking.
 Tic disorders are usually treated with risperidone
(Risperdal) or olanzapine (Zyprexa), which are
atypical antipsychotics. It is important for clients
with tic disorders to get plenty of rest and to manage
stress because fatigue and stress increase symptoms
Tourette disorder
 Tourette disorder involves multiple motor tics and
one or more vocal tics, which occur many times a day
for more than 1 year. The complexity and severity of
the tics change over time, and the person experiences
almost all the possible tics described previously
during his or her lifetime.
Chronic Motor or Tic Disorder
 Chronic motor or vocal tic differs from Tourette
disorder in that either the motor or the vocal tic is
seen, but not both. Transient tic disorder may involve
single or multiple vocal or motor tics, but the
occurrences last no longer than 12 months.
Learning Disorders
 A specific learning disorder is diagnosed when a
child's achievement in reading, mathematics, or
written expression is below that expected for age,
formal education, and intelligence. Learning
problems interfere with academic achievement and
lite activities requiring reading, math, or writing.
 Low self-esteem and poor social skills are common
in children with learning disorders. As adults, some
have problems with employment or social
adjustment; others have minimal difficulties. Early
identification of the learning disorder, effective
intervention, and no coexisting problems is
associated with better outcomes.
Motor Skills Disorder
 The essential feature of developmental coordination
disorder is impaired coordination severe enough to
interfere with academic achievement or activities of
daily living. This diagnosis is not made if the
problem with motor coordination is part of a general
medical condition, such as cerebral palsy or
muscular dystrophy.
Stereotypic movement disorder
 Stereotypic movement disorder is characterized by
rhythmic, repetitive behaviors, such as hand waving,
rocking, head banging, and biting, that appears to
have no purpose.
COMMUNICATION DISORDER
Communication disorder
 Involves deficits in language, speech, and
communication and is diagnosed when deficits are
sufficient to hinder development, academic
achievement, or activities of daily living, including
socialization.
Language disorder
- Involves deficit(s) in language production or
comprehension, causing limited vocabulary and an
inability to form sentences or have a conversation.
Speech sound disorder
- It is difficulty or inability to produce intelligible
speech, which precludes effective verbal
communication.
- Stuttering is a disturbance of fluency and patterning
of speech with sound and syllable repetitions.
Social communication disorder
- Involves the inability to observe social "rules" of
conversation, deficits in applying context to
conversation, inability to tell a story in an
understandable manner, and inability to take turns
talking and listening with another.
ELIMINATION DISORDERS
Encopresis
- It is the repeated passage of feces into inappropriate
places such as clothing or the floor by a child who is
at least 4 years of age either chronologically or
develop mentally.
1. Involuntary encopresis
- Usually associated with constipation that
occurs for psychological, not medical,
reasons.
2. Intentional encopresis
- is often associated with oppositional defiant
disorder (ODD) or conduct disorder.
Enuresis
- It is the repeated voiding of urine during the day or at
night into clothing or bed by a child at least 5 years
of age either chronologically or developmentally.
- Imipramine (Tofranil), an antidepressant with a side
effect of urinary retention. Both elimination disorders
respond to behavioral approaches.
 Both encopresis and enuresis are more common in boys
than in girls; 1% of all 5-year-olds have encopresis and
5% of all 5-year-olds have enuresis. Encopresis can
persist with intermittent exacerbations for years, it is
rarely chronic. Only 1% of all cases persist into
adulthood.
 Impairment associated with elimination disorders depends
on the limitations on the child's social activities, effects on
 self-esteem, degree of social ostracism by peers, and
anger, punishment, and rejection on the part of parents or
caregivers.
Sluggish cognitive tempo (SCT)
- A syndrome that is not a DSM-5 diagnosis. It
includes daydreaming, trouble focusing and paying
attention, mental fogginess, staring, sleepiness, little
interest in physical activity, and slowness in finishing
tasks.
ATTENTION-DEFICIT/HYPERACTIVITY DISORDER
(ADHD)
 Characterized by inattentiveness, overactivity, and
impulsiveness.
 ADHD is a common disorder, especially in boys, and
probably accounts for more child mental health
referrals than any other single disorder.
 The essential feature of ADHD is a persistent pattern
of inattention and/or hyperactivity and impulsivity
more common than generally observed in children of
the same age.
 To avoid overdiagnosis of ADHD, a qualified
specialist, such as a pediatric neurologist or a child
psychiatrist, must conduct the evaluation for ADHD.
 It is essential to have a thorough and accurate
diagnosis for ADHD. There are other disorders and
situations that may look similar to ADHD, such as
bipolar disorder or behavioral acting out in response
to family stress.
Onset and Clinical Course
 ADHD is usually identified and diagnosed when the
child begins preschool or school, though many
parents report problems from a much younger age.
As infants, children with ADHD are often fussy and
temperamental and have poor sleeping patterns.
 Toddlers may be described as "always on the go"
and "into everything," at times dismantling toys and
cribs. They dart back and forth, jump and climb on
furniture, run through the house, and cannot tolerate
sedentary activities such as listening to stories.
By the time the child starts school, symptoms of ADHD begin
to interfere significantly with behavior and performance:
 The child fidgets constantly
 In and out of assigned seats
 Makes excessive noise by tapping or playing with
pencils or other object
 Normal environmental noises
 He or she cannot listen to directions or complete
tasks.
 The child interrupts and blurts out answers before
questions are completed.
 Socially, peers may ostracize or even ridicule the
child for his or her behavior. Forming positive peer
relationships is difficult because the child cannot play
cooperatively or take turns and constantly interrupts
others.
 Studies have shown that both teachers and peers
perceive children with ADHD as more aggressive,
bossier, and less likable. This perception results from
the child's impulsivity, inability to share or take turns,
tendency to interrupt, and failure to listen to and
follow directions.
 Thus, peers and teachers may exclude the child from
activities and play, may refuse to socialize with the
child, and/or may respond to the child in a harsh,
punitive, or rejecting manner.
 Previously, it was believed that children outgrew
ADHD, but it is now known that ADHD can persist
into adulthood. Estimates are that 60% of children
with ADHD have symptoms that continue into
adulthood. In one study, adults who had been treated
for hyperactivity 25 years earlier were three to four
times more likely than their brothers to experience
nervousness, restlessness, depression, lack of friends,
and low frustration tolerance.
 Approximately 70% to 75% of adults with ADHD
have at least one coexisting psychiatric diagnosis,
with social phobia, bipolar disorder, major
depression, and alcohol dependence being the most
common
ETIOLOGY
Although much research has taken place, the definitive causes
of ADHD remain unknown.
 There may be cortical-arousal, information-
processing, or maturational abnormalities in the
brain.
 Combined factors
 Prenatal exposure
Brain images of people with ADHD suggest decreased
metabolism in the frontal lobes.
Studies have also shown decreased blood perfusion of the
frontal cortex in children with ADHD and frontal cortical
atrophy in young adults with a history of childhood ADHD.
Another study showed decreased glucose use in the frontal
lobes of parents of children with ADHD who had ADHD
themselves.
There seems to be a genetic link for ADHD that is most likely
associated with abnormalities in catecholamine and serotonin
metabolism.
Risk factors for ADHD:
 family history of ADHD
 female relatives with somatization disorder
 lower socioeconomic status
 male gender
 marital or family discord, including divorce,
neglect, abuse, or parental deprivation
 low birth weight
 various kinds of brain insult
TREATMENT
  No one treatment has been found to be effective for
ADHD, this gives rise to many different approaches
such is sugar-controlled diets and megavitamin
therapy.
 ADHD is chronic. Goals of treatment involve
managing symptoms, reducing hyperactivity and
impulsivity, and increasing the child's attention.
Psychopharmacology
STIMULANTS:
 Methylphenidate - It is a stimulant that reduces
hyperactivity, impulsivity, and mood lability and
helps the child pay attention more appropriately.
 Amphetamine compound (Adderall) - increasing
mental alertness and improving the ability to focus.
 Dextroamphetamine (Dexedrine) and pemoline
(Cylert) - are other stimulants used to treat
ADHD.
The most common side effects:
- Insomnia, loss of appetite, and weight loss or failure
to gain weight.
Psychopharmacology
When stimulant medications are not effective or their side
effects are intolerable, antidepressants are the second choice
for treatment
Atomoxetine (Strattera) - The only nonstimulant drug
specifically developed and tested by the U.S. Food and Drug
Administration for the treatment of ADHD. It is an
antidepressant, specifically a selective norepinephrine
reuptake inhibitor.
The most common side effects:
In children:
- Decreased appetite, nausea, vomiting, tiredness, and
upset stomach.
In adults:
- Insomnia, dry mouth, urinary retention, decreased
appetite, nausea. Vomiting, dizziness, and sexual side
effects.
Psychopharmacology
Strategies for Home and School:
 Behavioral strategies are necessary to help the child
master appropriate behaviors.
 Environmental strategies at school and home can
help the child succeed in those settings.
o In therapeutic play:
 Play techniques are used to understand the child's
thoughts and feelings and to promote communication.
 Dramatic play is acting out an anxiety-producing
situation.
 Creative play techniques can help children to
express themselves
NURSING INTERVENTION FOR ADHD
 Ensuring the child's safety and that of others
o Stop unsafe behavior
o Provide close supervision.
o Give clear directions about acceptable and
unacceptable behavior.
 Improved role performance
o Give positive feedback for meeting
expectations.
o Manage the environment
 Simplifying instructions/directions
- Get child's full attention
- Break complex tasks into small steps.
- Allow breaks.
 Structured daily routine
- Establish a daily schedule. •
- Minimize changes.
 Client/family education and support: Listen to parent's
feelings and frustrations.
MENTAL HEALTH PROMOTION
 The SNAP-IV Teacher and Parent Rating Scale is an
assessment tool that can be used for initial evaluation in
many areas of concern such as ADHD, ODD, conduct
disorders, and depression.
 Early identification and treatment of ASD are needed to
help children with these disorders reach their maximum
potential. Insufficient knowledge about ASD and
embarrassment or reluctance to have a child diagnosed
with ASD are reasons that some parents are hesitant to
have children evaluated if signs of developmental delays
are present.
 There is a high comorbidity between ADHD and other
disorders including substance use/abuse, antisocial
behavior, anxiety disorders, and mood disorders.
 To promote health through adulthood, individuals with
ADHD could benefit from strategies to prevent other
psychiatric disorders as well as early identification and
treatment of coexisting disorders.
Disruptive Behavior Disorders
INTRODUCTION
Disruptive behavior disorders include problems with
the person's ability to regulate his or her own emotions or
behaviors. They are characterized by persistent patterns of
behavior that involve anger, hostility, and/or aggression
toward people and property.
Oppositional defiant disorder (ODD), conduct
disorder, and intermittent explosive disorder (IED). It has
been posited by some psychiatrists that ODD and conduct
disorder can be viewed on a continuum concept that would
include antisocial personality disorder. Others believe that
ODD is a milder variant of conduct disorder.
Related Disorders

Kleptomania
 Characterized by impulsive, repetitive theft of
items not needed by the person, either for personal
use or monetary gain.
 Tension and anxiety are high prior to the theft, and
the person feels relief, exhilaration, or gratification
while committing the theft. The item is often
discarded after it is stolen.
 More common in females and often has negative
legal, career, family, and social consequences.
Related Disorders
Pyromania
 Characterized by repeated, intentional fire-setting.
 The person is fascinated about fire and feels pleasure
or relief of tension while setting and watching the fires.
 There is neither any monetary gain or revenge or
other reason, such as concealing other crimes, nor is it
associated with another major mental disorder.
 Pyromania as a primary disorder is rare. Persons, if
caught, become part of the legal rather than mental health
system.
OPPOSITIONAL DEFIANT DISORDER
❏ Consists of an enduring pattern of uncooperative,
defiant, disobedient, and hostile behavior toward
authority figures without major antisocial violations.
❏ A certain level of oppositional behavior is common
in children and adolescents, indeed, it is almost
expected at some phases such as 2 to 3 years of age
and in early adolescence.
Acceptable Characteristics & Abnormal Behavior in
Adolescence
The disruptive, defiant behaviors usually begin at home with
parents or parental figures and are more intense in this setting
than settings outside the home.
The prevalence rates of ODD vary from 2% up to
15% of the adolescent population, which highlights the
difficulty of distinguishing negative behavior from ODD and
conduct disorder-type behaviors. Average prevalence in the
United States is estimated at 3%. It occurs more often in
males; however, ODD in female adolescents has increased in
recent years. Most authorities believe that genes,
temperament, and adverse social conditions interact to create
ODD. Children with ODD have lower self-concept and lack
competence in social situations.
Children with ODD have limited abilities to make
associations between their behavior and consequences of
behavior-both negative and positive, indicative of a reduced
sensitivity to reward and punishment.
Therefore, learning appropriate behavior and learning
to refrain from inappropriate behavior are impaired. They also
exhibit impaired problem-solving abilities and deficiencies in
attention, flexibility of thinking, and decision-making. All of
these problems are also present in children diagnosed with
conduct disorder-to an even greater degree.
Prognosis for ODD varies by age of onset, symptom
severity, and the presence of comorbid psychiatric disorders.
Early onset, more severe symptoms, and comorbid conditions
are associated with poorer long-term outcomes.
Children with this disorder can develop conduct
disorder; some will be diagnosed with antisocial personality
disorder as adults. ODD is often comorbid with other
psychiatric disorders such as attention-deficit/hyperactivity
disorder (ADHD), anxiety, and/or mood disorders that need to
be treated as well.
Treatment for ODD is based on parent management
training models of behavioral interventions.
A hierarchy of problem behaviors is developed, and
the most disruptive or problematic behaviors are targeted for
intervention. Parents learn to ignore maladaptive behaviors
rather than giving the behaviors negative attention, positive
behaviors are rewarded with praise and reinforcers and
consistent consequences for the child's defiant behavior are
implemented every time the behavior occurs.
Adolescent children benefit from interventions that
use enhancement of personal strengths to improve behavioral
and social functioning. Older children may also benefit from
individual therapy in addition to the behavioral program. In
addition, focus on supporting the parents improves overall
outcomes. Primary caregivers report that challenges can be
overwhelming, demanding, and unrelenting. The two major
challenges for parents and caregivers are managing the
adolescent's aggressive, defiant, and deceitful behaviors, and
interacting frequently with multiple service providers and
agencies.
INTERMITTENT EXPLOSIVE DISORDER
 Involves repeated episodes of impulsive,
aggressive, violent behavior, and angry verbal
outbursts usually lasting less than 30 minutes.
 there may be physical injury to others, destruction
of property, and injury to the individual as well.
 The intensity of the emotional outburst is grossly
out of proportion to the stressor or situation.
 The episode may occur with seemingly no warning.
Afterward, the individual may be embarrassed and
feel guilty or remorseful for his or her actions. But
that does not prevent future impulsive, aggressive
outbursts.
 The onset of IED can occur at any time in life but
is most common in adolescence and young
adulthood.
 It is more common in males than in females.
 most commonly substance use/abuse, ADHD,
ODD, conduct disorder, anxiety disorders, and
depression.
 IED is related to childhood exposure to trauma,
neglect, or maltreatment.
  neurotransmitter imbalances, especially serotonin:
plasma tryptophan depletion; and frontal lobe
dysfunction.
 coronary heart disease, hypertension, stroke,
diabetes, arthritis, back/neck pain, ulcer, headache,
and other chronic pain.
Treatment for IED includes medications
fluoxetine (Prozac); lithium; and anticonvulsant mood
stabilizers such as valproic acid (Depakote), phenytoin
(Dilantin),topiramate (Topamax), and oxcarbazepine
(Trileptal).
Selective serotonin reuptake inhibitor antidepressants
particularly seem to reduce aggressive tendencies.
Cognitive behavioral therapy, anger management strategies,
avoidance of alcohol and other substances, and relaxation
techniques.
CONDUCT DISORDER
 Characterized by persistent behavior that violates
societal norms, rules, laws, and the rights of others.
 Impaired abilities to function in social, academic,
or occupational areas.
 Symptoms are clustered in four areas: aggression to
people and animals, destruction of property,
deceitfulness and theft, and serious violation of
rules.
 Children with conduct disorder often exhibit
callous and unemotional traits, similar to those
seen in adults with antisocial personality disorder.
 They have little empathy for others, do not feel
"had" or guilty or show remorse for their behavior,
have shallow or superficial emotions, and are
unconcerned about poor performance at school or
home.
 These children have low self-esteem poor
frustration tolerance, and temper outbursts.
 Conduct disorder is frequently associated with
early onset of sexual behavior, drinking smoking
use of illegal substances, and other reckless or risky
behaviors. In the United States, of children and
adolescents have conduct disorder. Onset of
conduct disorder behaviors before age 10 occurs
primarily in boys, onset alter age 10 occurs in girls
and boys. As many as 30% to 50% of these
children are diagnosed with antisocial personality
disorder as adults.
ONSET and CLINICAL COURSE
Two subtypes of conduct disorder are based on age at onset.
 Childhood-onset type- involves symptoms before 10
years of age, including physical aggression toward
others and disturbed peer relationships.
 Adolescent-onset type- is defined by no behaviors of
conduct disorder until after 10 years of age.
Behaviors associated with conduct disorders fall into
categories of aggression, destruction, deceiv/theft, and rule
violation, but they can vary in intensity.
 Mild: The child has some conduct problems that
cause relatively minor harm to others.
Examples include repeated lying, truancy,
minor shoplifting, and staying out late without
permission.
 Moderate: The number of conduct problems
increases as does the amount of harm to others.
Examples in clude vandalism, conning
others, running away from home. verhal bullying and
intimidation, drinking alco hol, and sexual
promiscuity
 Severe: The person has many conduct problems that
cause considerable harm to others.
Examples include forced sex cruelty to
animals, physical fights, cruelty to peers, use of a
weapon, burglary, robbery, and violation of previous
parole or probation requirements.
ETIOLOGY
Researchers generally accept that genetic vulnerability,
environmental adversity, and factors such as poor coping
interact to cause the disorder.
Risk factors:
 poor parenting
 low academic achievement
 poor peer relationships
 low self-esteem
There is a genetic risk for conduct disorder, though no specific
gene marker has been identified. The disorder is more
common in children who have a sibling with conduct disorder
or a parent with antisocial personality disorder, substance
abuse, mood disorder, schizophrenia, or ADHD.
A lack of reactivity of the autonomic nervous system
has been found in children with conduct disorder, this
unresponsiveness is similar to adults with antisocial
personality disorder. The abnormality may cause more
aggression in social relationships as a result of decreased
normal avoidance or social inhibitions.
 Poor family functioning
 marital discord
 poor parenting
 a family history of substance abuse and psychiatric
problems
Studies have shown that adolescents with conduct disorder
had their first experience with alcohol and other drugs before
age 12 years and were more likely to engage in higher risk
behaviors, including, but not limited to, continued alcohol and
substance use. Prenatal exposure to alcohol causes an
increased risk for conduct disorder. Child abuse is an
especially significant risk factor.
 The specific parenting patterns considered ineffective
are inconsistent parental responses to the child's
demands and giving into demands as the child's
behavior escalates.
 Exposure to violence in the media and community is
a contributing factor for the child at risk in other
areas. Socioeconomic disadvantages, such as
inadequate housing, crowded conditions, and
 poverty, also increase the likelihood of conduct Preschool programs, such as Head Start, result in lower rates
disorder in at-risk children. of delinquent behavior and conduct disorder through use of
parental education about normal growth and development,
 Academic underachievement, learning disabilities, stimulation for the child, and parental support during crises.
hyperactivity, and problems with attention span are
all associated with conduct disorder. For school-aged children with conduct disorder, the child,
 Children with conduct disorder have difficulty family and school environment are the focus of treatment.
functioning in social situations  parenting education
 Lack the abilities to respond appropriately to others  social skills training to improve peer relationships
& to negotiate conflict, lose ability to restrain  Attempts to improve academic performance and
themselves when emotionally stressed. increase the child's ability to comply with demands
 They are often accepted only by peers with similar from authority figures.
problems. Family therapy is considered to be essential for children in
this age group.
Related Problems
Externalizing and Internalizing Behaviors Adolescents rely less on their parents and more on peers, so
❖ Externalizing Behaviors treatment for this age group includes individual therapy.
The most promising treatment approach includes keeping the
 Lying client in his or her environment with family and individual
 Cheating at school therapies.
 Swearing  conflict resolution
 Truancy  anger management
 Vandalism  teaching social skills.
 Setting fires
Medications alone have little effect, but may be used in
 Bragging
conjunction with treatment for specific symptoms.
 Screaming
For example, the client who presents a clear danger to others
 Inappropriate attention-seeking (physical aggression)
 Arguing  Risperidone (Risperdal)
 Threatening
 Demanding Nursing Interventions: Conduct Disorder
 Relentless teasing
 Anger outbursts  Encourage the client to discuss his or her thoughts
and feelings.
❖ Internalizing Behaviors  Give positive feedback for appropriate discussions.
 Prefers to be alone o Tell the client he or she is accepted as a
 Withdraws person, though a particular behavior may
 Sulks not be acceptable.
 Won't talk  Give the client positive attention when behavior is
 Is secretive not problematic.
 Overly shy  Teach the client about limit setting and the need for
 Stares in lieu of verbal response limits. Include time for discussion.
 Physically underactive  Teach the client the problem-solving process as an
 Somatic aches and pains alternative to acting out (identify the problem,
 Dizziness consider alternatives, select and implement an
 Nausea, vomiting, stomach problems alternative, and evaluate the effectiveness of the
 Fatigue, lethargy solution).
 Lonely  Help the client practice the problem-solving process
 Guilt feelings with situations on the unit, then situations the client
 Nervous may face at home, school, and so forth.
 Crying spells  Role model appropriate conversation and social skills
 Feels worthless, unloved for the client.
 Specify and describe the skills you are demonstrating
Treatment  Practice social skills with the client on a one-on-one
Dramatic interventions, such as "boot camp” or incarceration, basis
have not proved effective and may even worsen the situation.
Treatment must be geared toward the client's developmental  Gradually introduce other clients into the inter-actions
age; no one treatment is suitable for all ages. and discussions.
 Assist the client in focusing on age- and situation-
appropriate topics.
 Encourage the client to give and receive feedback with
others in his or her age group.
 Facilitate expression of feelings among clients in
supervised group situations.
 Teach the client about transmission of HIV in-fection and
other sexually transmitted diseases(STDs).
 Assess the client's use of alcohol or other substances, and
provide referrals as indicated.