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Child and Adolescent disorders

Child and adolescent disorders Psychiatric disorders are not diagnosed as easily in children as they are in adults. Children lack the abstract cognitive abilities and verbal skills to describe what is happening.

Mental retardation
is a generalized disorder appearing before adulthood, characterized by significantly impaired cognitive functioning and deficits in two or more adaptive behaviors.

Delays in oral language development Deficits in memory skills Difficulty learning social rules Difficulty with problem solving skills Delays in the development of adaptive behaviors such as self-help or self-care skills Lack of social inhibitors
It has historically been defined as an Intelligence Quotient score under 70

Classification:
1.Mild retardations: IQ 50-70 2.Moderate retardation: IQ 35-50 3.Severe retardation: IQ 20-35 4.Profound retardation: IQ less than 20.

BORDERLINE INTELLECTUAL FUNCTIONING 70-84

Adolescent depression
Some issues are due to background and family issues Transition into adulthood often very difficult Depression is almost always due to a combination of factors Boys are more successful in committing suicide; more violent in attempts
Acetaminophen affects liver Ibuprophen affects kidneys

Presents as classic symptoms in girls In boys, depression is more likely to be acted out with aggressive behavior such as risk taking, substance abuse, confrontations with authority. First major episode are during adolescent years; often between the ages of 15-19

Manic depression
Teens may be sad and gloomy one day and excited and elevated the next Mood stabilizers are important in decreasing mood swings
Lithium (check blood levels!) Depakote Tegretol Neurontin

In depression, one of the first cues is a large drop in school performance

Other symptoms disguised:


Drug/alcohol abuse Lack of concentration Restlessness or hyperactivity Anti-social behavior (conduct disorder)

Extreme fatigue, sleep all the time but are not rested Suicide warning signs
Constant insomnia; may be on computer at all hours of the night Changes in behavior Dropping gradesagain, school is a huge issue

Interventions for suicide


High risk teens make their decisions after a disaster has occurred: break-ups, academic failure, fight with parents, or run-in with authority

Alcohol is involved in of all suicides; seriously impairs judgement

Suicide is not chosen; it happens when pain exceeds resources for pain

Talking to their kids!


The best place is in the car when theyre trapped.
Start with the basics; How are you doing? praises

. get down and dirty to the real subject

Childhood Schizophrenia Group of disorders of thought processes characterized by gradual disintegration of mental function Occurs in adolescents or as young adults Suicide is the #1 cause of death in young people with schizophrenia Treatment and prognosis
Lifetime of therapy and family support Medications Struggle for family to stay involved
Often rejected or just cant take anymore disruption in their lives.

Obsessive-Compulsion disorder
Symptoms often begin slowly and gradually during their childhood or teenage years and increase in severity as time goes on. Though a chronic disease, there will be periods of reduced symptoms followed by flareups, often stressful times in persons life. Relief is only temporary; usually both obsessions and compulsions occur together Recognize thoughts or behaviors are irrational; but are compelled to continue them against their will.

Treatment:
Exposure and response prevention SSRIs help reduce symptoms of OCD monitor for side effects

Compulsions
Washing, cleaning, constant checking, mental counting rituals Touching, ordering, rearranging Asking for reassurance or confessing Masturbationespecially seen in children who havent yet discovered this is socially unacceptable behavior

Autistic disorder
Most prevalent in boys; identified no later than 3years of age Child has little eye contact, few facial expression, doesnt use gestures to communicate Does not relate to parents or peers, lacks spontaneous enjoyment, apparent absence of mood and emotional affect, cannot be engaged in play or make believe Repetitive motor behaviors such as hand-flapping, body twisting, or head banging May improve as child acquires language skills

Short term impatient therapy is used when behaviors such as head banging or tantrums are out of control
Haldol or Risperadol may be effective ( prn, of course)

Goals of treatment:
Reduce behavioral symptoms Promotes learning and development
Language skills development

Attention deficit disorder


Characterized by patterns of inattention, hyperactivity, and impulsiveness Account for most mental health referrals Needs to be physically seen for a renewal of ADHD drugs monthly Often diagnosed when a child starts school

Signs and symptoms


Inattentive behaviors Hyperactive/impulsive behaviors
Fidgets Often leaves seat Cant play quietly Interrupts

Cannot wait turn

Treatment
The most effective treatment combines pharmacotherapy with behavioral, psychosocial, and educational interventions

Psychopharmacology
Methylphenidate (Ritalin) Amphetamine compound (Adderall) The most common side effects of these drugs are insomnia, loss of appetite, and weight loss or failure to gain weight. Giving stimulants during daytime hours usually combats insomnia. Give the child breakfast and snacks to gain weight Atomoxetine (Strattera) Non-stimulant drug; is an antidepressantselective norepinephrine reuptake inhibitor. Most common side effects were decreased appetite, N/V, tiredness, and upset stomach. Can cause liver damage, must have liver function tests periodically.

Strategies for Home and School Behavioral strategies are necessary to help the child master appropriate behaviors. Effective approaches: Provide consistent rewards Consequences for behavior Offer consistent praise Use time out Give verbal reprimands Use daily report cards for behavior Point system for positive and negative behavior Therapeutic play; use play to understand thoughts and feelings and helps with communication. Educate parents!

Conduct disorder
Characterized by persistent antisocial behavior in children and adolescents that significantly impair their ability to function in social, academic, or occupational area.
Symptoms are clustered into 4 areas
Aggression to people and animals Destruction to property Deceitfulness and theft Serious violation of rules and the law Decreased self-esteem Poor frustration tolerance Tempter often out of control Early onset of sexual behavior, alcohol and substance abuse, smoking, risky behavior

More symptoms

Anti-social

Types of conduct disorder


Classified by age of onset
Adolescent-onset type is defined by no behaviors of conduct disorder until after 10 years of age.
Least likely to be aggressive Have more normal peer relationships Less likely to have persistent conduct disorder or antisocial personality disorder as adults

Childhood - onset type involves symptoms


before10 years of age Physically aggressive Disturbed peer relationships More likely to have persistent conduct disorder and to develop antisocial personality disorder as adults

Can be classified as:


Mild: few conduct problems causing minor harm to others
Lying, truancy, staying out late without permission

Moderate: Number of conduct problems increase as does the amount of harm to others.
Vandalism and theft

Severe: Many conduct problems that cause considerable harm to others.


Forced sex, cruelty to animals, weapons, burglary, robbery.

Treatment of conduct disorder


MUST BE GEARED TOWARD DEVELOPMENTAL AGE School aged:
Child, family, and school environment are the focus of treatment
Family therapy is essential

Adolescents
Rely less on their parents, so treatment is based on individual therapy. Conflict resolution, anger management, social skills Try to keep the adolescent in his environment (home)

Medications have little effect


Antipsychotics for clients who present a clear danger to others Mood stabilizers for clients with labile moods

Oppositional Defiant disorder


Consists of an enduring pattern of uncooperative, defiant, and hostile behavior toward authority figures without major antisocial violations. A certain level of oppositional behavior is common in children and in adolescence.

Oppositional defiant disorder is diagnosed only when behaviors are more frequent and intense than unaffected peers and cause dysfunction in social, academic, or work situations.

TIC disorders
Sudden, rapid, recurrent, non-rhythmic motor movement or vocalization Stress and fatigue exacerbates tics Treatment: Risperadol and Zyprexia Complex vocal tics
Coprolalia: Use of socially unacceptable words, often obscene Palilalia: Repeating own sounds or words Echolalia: Repeating the last heard sound, word, or phrase

Tourettes syndrome Multiple motor tics and one or more vocal tics May occur many times a day for over a year Usually identified by 7 years of age

Elimination disorders
Encopresis: repeated passage of feces into inappropriate places such as clothing or floor by a child who is at least 4 years of age either chronically or developmentally.
Often involuntary, but can be intentional (oppositional defiant disorder or conduct disorder).

Enuresis: Repeated voiding of urine during the day or night into clothing or bed by a child at least 5 years of age.

Treated with imipramine (Tofranil), an antidepressant with a side effect of urinary retention.
Was once treated with vasopressin which decreases circulatory volume.

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