NURSING MANAGEMENT OF CHILDHOOD AND ADOLESCENT DISORDER INCLUDING MENTAL DEFICIENCY.pptx

Child and adolescent psychiatry (pediatric psychiatry) is a branch of psychiatry that focuses on the diagnosis, treatment, and prevention of mental disorders in children, adolescents, and their families. It investigates the biopsychosocial factors that influence the development and course of psychiatric disorders and treatment responses to various interventions. Child and adolescent psychiatrists primarily use psychotherapy and/or medication to treat mental disorders in the pediatric population.

1. CHILDHOOD & ADOLESCENT DISORDER SLMGNC TALHATI ABU ROAD AMRITANSHU CHANCHAL NURSING TUTOR

2. Introduction Child psychiatry is primarily concerned with the study and treatment of behavioral disorders and emotional problems that affect children. Emotional maladjustments of children frequently are characterized by anxiety reactions. Child and adolescent psychiatry  ( pediatric psychiatry ) is a branch of psychiatry that focuses on the diagnosis, treatment, and prevention of mental disorders in children, adolescents, and their families. It investigates the biopsychosocial factors that influence the development and course of psychiatric disorders and treatment responses to various interventions. Child and adolescent psychiatrists primarily use psychotherapy and/or medication to treat mental disorders in the pediatric population.

3. History of child Psychiatry Child psychiatry has been recognized as a division of the field of psychiatry and neurology since the mid 1920s. By about the mid-1950s, the American Board of Psychiatry and Neurology had officially recognized the subspecialty and defined training and certification requirements for it. Adequacy of mental health care to children and adolescents is a sensitive indicator of the level of development of the country. The first ever child guidance clinic (CGC) in India was started by the Tata Institute of Social sciences, Mumbai in 1937. The Indian Council for Mental Hygiene was established in Mumbai, which paved the way for establishment of CGCs across the country in the 1940’s.

4. Most of these centres were located in metropolitan cities and the scope of services offered was variable. The CGC at the All India Institute of Mental Health, Bangalore (the present National Institute of Mental Health and Neurosciences-NIMHANS) started functioning since 1959. The first school for children with Mental retardation was started by the society for Care, Prevention and Rehabilitation of Mentally retarded children in Mumbai.

5. ICD Classification

6. Mental Retardation (F70-79) Mental Retardation refers to significantly sub-average general intellectual functioning resulting in or associated with concurrent impairments in adaptive behavior and manifested during the developmental period. (ANA). General Intellectual functioning is defined as the result obtained by the administration of the standardized general intelligence tests developed for the purpose, and adopted to the conditions of the region / country.

7. During infancy, childhood, adolescence and late adolescence following areas must be observed for maladaptive behavior: During infancy & childhood During childhood & adolescence During late childhood Sensory & motor developmental Application of basic academic skill to daily life activities Vocational and social responsibilities Communication skills Application of appropriate reasoning and judgement in the mastery of the environment Self help skills & Socialization Social skills

8. Epidemiology

9. Etiology

10. Classification of mental retardation based on IQ Type Intelligence Quotient Mild 50-70 Moderate 35-50 Severe 20-35 Profound <20

11. Behavioral manifestation of mentally retarded children Types of retardation Mild retardation Moderate retardation Severe retardation Profound retardation Self care ability The child may be able to live somewhat independently with monitoring The child requires close supervision and must be supervised when performing certain independent activities The child requires complete supervision but may be able to perform simple hygiene skills, such as brushing teeth The child requires constant assistance & supervision Educational level The child can achieve reading skills up to the level of primary school and master vocational training The child can achieve skills up to second class & may be trained in skills to participate in workshop May learn a few simple skills The child cannot benefits from academic training

12. Social Skills The child can learn and use social skills in structured setting The child has certain speech limitations & difficulty following expected social norms The child has limited verbal skills and tends to communicate needs non verbally The child has little speech development and lacks social skills Psychomotor skills The child can develop average to good skills but may experience minor co-ordination problems The child may have difficulty with gross motor skills and may have limited vocational opportunities The child has poor psychomotor skills with limited ability to perform simple task even under direct supervision The child lacks both fine and gross motor skills Economic Situation The child can perform a job under close supervision and mange money with proper guidance The child may learn to handle a small amount of pocket money as well as how to make changes The child may be taught how to use money and supervised when shopping The child must depend on others for money management

13. Delayed in achieving sitting, crawling, and walking Learn to talk later, or can have trouble in speaking Poor memory-find it hard to remember things Does not understand how to pay attention for things Have trouble in understanding social rules Have trouble solving problems Have trouble thinking logically Characteristics / common features of ID / MR

14. Associated Problems with Intellectual Disability / Mental Retardation Seizure disorder Drooling Hypothyroidism Microcephaly Vision problems Hearing problems Anxiety Mood disorders

15. Diagnosis ID / MR is diagnosed by looking at two main things. These are: The ability of a person's brain to learn, think, solve problems, and make sense of the world (called IQ or intellectual functioning) Whether the person has the skills he or she needs to live independently (called adaptive behavior or adaptive functioning). People scoring below 70 IQ are thought to have ID / MR. To measure adaptive behavior, professionals look at what a child can do in comparison to other children of his or her age. Certain skills are important to adaptive behavior. These are: Daily living skills, such as getting dressed, going to the bathroom, and feeding one's self Communication skills, such as understanding what is said and being able to answer Social skills with peers, family members, adults, and others

16. Neurological Examination A neurological exam evaluates brain and nervous system functioning. It’s a series of tests that assesses mental status, reflexes, movements and more. You may benefit from this test if you show signs of a neurological disorder. It includes a series of physical examination steps that assess nervous system functioning. These may include evaluation of your: Mental status (cognition) and speech. Cranial nerve (nerves of your head and face) function. Strength, coordination and muscle tone. Reflexes (such as “knee jerk”) and others. Perception of feeling in different parts of your body to different stimulation, like touch and vibration. Gait and mobility. Spine. Level of consciousness, after a traumatic brain injury

17. Treatment Modalities Education support and interventions . These can help with changes to educational programs and structure. An example of educational support is an Individualized Education Plan (IEP), which creates a custom educational plan and expectations. Behavioral support and interventions.  These kinds of interventions can help with learning adaptive behaviors and related skills. Vocational training.  This can help people with intellectual disabilities learn work-related skills. Family education.  This can help family and loved ones of those with intellectual disability learn more about intellectual disability and how to support a loved one who has it. Various medications  can help with conditions that are related to or happen alongside intellectual disability. While these don’t treat intellectual disability itself, they can help with some of the symptoms that may contribute. Community support . A person and/or their family can contact local government agencies or support organizations. Doing so can help them get access to the services they benefit from, including supports in home or work environments and options for daytime activities.

18. Primary Preventions Primary prevention focuses on the prevention of mental health disorders in the community before they occur. This level of prevention aims to decrease risk factors and increase protective factors in order to prevent a mental health disorder from occurring in the first place. Examples of primary prevention activities include youth groups and clubs, which help to increase community bonds and support; parenting classes; and education to prevent substance abuse, which is a key risk factor for a number of mental health disorders. Decreasing substance abuse has the effect of decreasing the number of mental health disorders in a community.

19. Secondary Prevention Secondary prevention focuses on the early detection and prompt intervention of mental health disorders. At this level of prevention, a patient already has a mental health disorder, and secondary prevention is aimed at detecting the disorder early in order to intervene promptly. Essentially, this means screening. Screening patients for depression or suicide risk, for example, can lead to the early intervention ― and prevention — of a more dire outcome. Suicide hotlines and crisis centers may also be categorized as secondary prevention, where the disorder already exists, but mitigation is possible before the disorder escalates. In this case, speaking to a social worker or trained suicide prevention specialist may help alleviate the situation.

20. Tertiary Prevention Tertiary prevention focuses on the period after a mental health disorder or crisis has already occurred. The focus at this point is to help promote the patient's recovery as well as to prevent further complications. Examples of tertiary prevention include outpatient support for a patient following a hospitalization related to a mental health disorder or crisis. It can include pharmacological therapy. And it can include support groups for family and friends of a patient who has died by suicide as a way for them to begin the healing process.

21. Legal Aspects concerning persons with mental Disability Mentally retarded are treated as persons with disabilities under section of the Persons with Disabilities Act, 995 (PWD Act). The statuary provision for the welfare of mentally retarded persons are: i ) PWD Act 1995 ii) National Trust 1999 Indian railways and some state governments have schemes for travel facility for persons with ability. The income Tax act allows deduction in respect of maintenance including medical treatment of a dependent who is a person with disability which includes mental retardation and mental illness under Section 80DD.

22. Care and Rehabilitation of the Mentally Retarded The main elements in a comprehensive services for mentally retarded individuals and their families include: Early detection and early stimulation of mental handicap Regular assessment of the mentally retarded person’s attainment disability Provision for education, training, occupation, or work appropriate for each handicapped persons Housing and social support to unable self care Medical nursing and other services for those who require them as outpatient day patient or inpatient Psychiatric and psychological services

23. General provision Mildly retarded Severely retarded Education & Training A few mildly retarded children require fostering, boarding schools placements services are not required. Mildly retarded adults may need help with housing employment or with the special problems of old age. Incase of children, some require special services throughout their lives, which may include a sitting service, day respite during school holidays, or overnight stays in a foster family or residential care. The aim is that as many mentally retarded children as possible are mentally retarded children schools either in normal classes or in special classes. There is now an increasing use of more specialist teaching and a variety of innovative procedures for teaching language and other methods of communication.

24. Nursing Management Disturbed Thought Processes Related to: Altered self-concept Cognitive dysfunction Low self-esteem Psychological barriers Anxiety Fear Stressors Substance misuse Unaddressed trauma  Social Isolation As evidenced by: Absence of eye contact Inaccurate interpretation of stimuli (external or internal) Decreased willingness to participate in social interactions Difficulty comprehending communication Inappropriate social behavior Cognitive dissonance Inappropriate verbalization Speech abnormalities Hallucinations/delusions Distractibility Suspiciousness Expected Outcomes: The patient will maintain reality orientation and communicate and interact with other people according to social norms The patient will recognize and implement strategies to manage hallucinations/delusions

25. Ineffective Coping Related to: Inadequate confidence in the ability to deal with a situation Inadequate sense of control Inadequate social support Ineffective tension release strategies Inadequate resources As evidenced by: Altered attention Altered communication pattern Destructive behaviors Difficulty organizing information Inability to ask for help Lack of goal-directed behavior Inadequate follow-through Inadequate problem-solving skills Substance abuse Expected Outcomes: The patient will demonstrate effective coping when faced with unfavorable situations The patient will verbalize confidence in dealing with psychosocial  issues

26. Chronic Low Self-esteem Related to: Disturbed body image Fear of rejection Inadequate social support Ineffective communication skills Insufficient approval from others Low self-efficacy Abandonment Domestic abuse As evidenced by: Depressive symptoms Excessive shame or guilt Constant seeking of reassurance Loneliness Passive behavior Overly-conforming behaviors Reduced eye contact Rejects positive feedback Reports repeated failures Self-negating verbalizations Expected Outcomes: The patient will verbalize an increased sense of self-worth The patient will demonstrate behaviors of improved self-esteem such as eye contact, appropriate physical appearance, posture, and participation in conversations

27. Disorders of psychological Development These are disorders in which normal patterns of language acquisition are disturbed from the early stages of development. The conditions are not directly attributable to neurological or speech mechanism abnormality or mental retardation. 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.

28. Specific Developmental Disorder of Scholastic Skills Dyslexia is one type of reading disorder. It generally refers to difficulties reading individual words and can lead to problems understanding text. Most reading disorders result from specific differences in the way the brain processes written words and text.  Usually, these differences are present from a young age. Developmental dyslexia  (specific reading and specific spelling disorder) is thought to stem from specific features in cognitive processing strongly related to biological maturation of the central nervous system which interact with non-biological learning conditions. Dyscalculia  is a learning disorder that affects a person's ability to do math. Much like dyslexia disrupts areas of the brain related to reading, dyscalculia affects brain areas that handle math- and number-related skills and understanding.

29. Specific Developmental Disorders of Motor Function Developmental co-ordination disorder (DCD), also known as dyspraxia, is a condition affecting physical co-ordination. It causes a child to perform less well than expected in daily activities for their age, and appear to move clumsily. Children with this disorder have delayed motor developmental, which is below the expected level on the basis of their age and general intelligence. The main features of this disorder is a serious impairment in the development of motor coordination, which results in clumsiness in school work.

30. Pervasive Developmental Disorder Pervasive developmental disorders (PDD) now known as autism spectrum disorder are a group of developmental delays that affect social and communication skills. The typical onset of PDD occurs around age 3, but some parents notice symptoms during infancy. Treatment typically involves therapy and medications. But now healthcare providers call it autism spectrum disorder (ASD). This name change occurred in 2013, when the American Psychiatric Association reclassified the four following conditions into one umbrella diagnosis in the DSM-5. Autistic disorder. Asperger’s syndrome. Childhood disintegrative disorder. Pervasive developmental disorder not otherwise specified (PDD-NOS).

31. Epidemiology Worldwide (2023) It is estimated that worldwide about 1 in 100 children has autism. This estimate represents an average figure, and reported prevalence varies substantially across studies. Some well-controlled studies have, however, reported figures that are substantially higher. The prevalence of autism in many low- and middle-income countries is unknown.

32. Childhood Autism Autism is a developmental disorder that appears in the first 3 years of life, and affects the brain's normal development of social and communication skills. Autism is a physical condition linked to abnormal biology and chemistry in the brain. The exact causes of these abnormalities remain unknown, but this is a very active area of research. There are probably a combination of factors that lead to autism. Genetic factors seem to be important. For example, identical twins are much more likely than fraternal twins or siblings to both have autism. Similarly, language abnormalities are more common in relatives of autistic children. Chromosomal abnormalities and other nervous system (neurological) problems are also more common in families with autism.

33. Etiology Genetic Factors Biochemical factors Perinatal factors Genetic factors are estimated to contribute 40 to 80 percent of ASD risk. The risk from gene variants combined with environmental risk factors, such as parental age, birth complications, and others that have not been identified, determine an individual's risk of developing this complex condition. At least 1/3 rd of patients with autistic disorders have elevated plasma serotonin Several studies have focused on the perinatal period. The factors associated with the development of ASD include gestational age (GA), caesarian delivery prematurity, congenital malformations, low birth weight (LBW) and birth asphyxia. Feeding difficulties might be a risk factor.

34. Psychodynamic & parenting Influence and social environment Theory of mind in autism Electrophysiological Changes Some of the specific causative factors proposed in these theories are parental rejection, child response to deviant parental personality characteristics, family break-up, family stress, insufficient stimulation and faulty communication patterns. Theory of mind describes the developmental process whereby the child comes to understand others minds or to anticipate what others may be thinking , feeling, or intending. Children with autistic disorder are sometimes said to be mind blind in that place of another person. Brain stem auditory Evoked Response of autistic children showed impairment in sensory modulation at brainstem level.

35. Clinical Features Avoids or does not keep eye contact Does not respond to name by 9 months of age Does not show facial expressions such as happy, sad, angry, and surprised by 9 months of age Does not play simple interactive games like pat-a-cake by 12 months of age Uses few or no gestures by 12 months of age (for example, does not wave goodbye) Does not share interests with others by 15 months of age (for example, shows you an object that they like) Does not point to show you something interesting by 18 months of age Does not notice when others are hurt or upset by 24 months (2 years) of age Does not notice other children and join them in play by 36 months (3 years) of age Does not pretend to be something else, like a teacher or superhero, during play by 48 months (4 years) of age Does not sing, dance, or act for you by 60 months (5 years) of age

36. Prognosis Autistic disorder has a long course and guarded prognosis About 10-20% autistic children begin to improve between 4 and 6 years of age eventually attend on ordinary school and obtain work 10-20% can live at home, but need to attend a special school or training center and cannot work 60 percent improve little and are unable to lead an independent life, mostly needing long-term residential care Those who improve may continue to show language problem, emotional coldness and odd behavior

37. Diagnosis No definitive diagnostic tool; usually diagnostic by age 3- after first ruling other disorder that resembles autism. Autism identifying methods by an autism specialist Observe your child and ask how your child's social interactions, communication skills and behavior have developed and changed over time Give your child tests covering hearing, speech, language, developmental level, and social and behavioral issues Present structured social and communication interactions to your child and score the performance Use the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association Include other specialists in determining a diagnosis Recommend genetic testing to identify whether your child has a genetic disorder such as Rett syndrome or fragile X syndrome

38. Specialists use standardized assessments during evaluations to help assess autism spectrum disorder in children. The Autism Diagnostic Observation Schedule (ADOS-2) is a standardized assessment of communication, social interaction, play, and restricted and repetitive behaviors in children. During an ADOS-2 assessment, a specialist interacts directly with the child in social and play activities. A neuropsychological evaluation involves cognitive and achievement testing, as well as further specialized testing of memory, attention, and executive function, to pinpoint a child’s abilities and deficits in learning and communicating. During this evaluation, the child’s parents provide our specialists with a comprehensive history of the child’s behavior and symptoms since birth. Our experts may also gather information from teachers or directly observe the child in the classroom.

39. Diagnosis Impaired Social Interaction related to deficits in communication and social skills. Risk for Injury related to sensory processing difficulties and self-stimulatory behaviors. Impaired Verbal Communication related to language impairments and difficulties in expressive language. Disturbed Sleep Patterns related to sensory sensitivities and sleep disturbances.

40. Nursing Intervention Impaired Social Interaction: Assess the patient’s communication abilities, social preferences, and strengths to develop an individualized plan of care. Encourage the patient to participate in social activities with peers, promoting social integration and developing social skills. Provide visual aids, social stories, and social skills training to enhance understanding and utilization of social cues. Collaborate with speech therapists and occupational therapists to address speech delays and sensory issues, which can impact social interaction. Risk for Injury: Create a safe and structured environment, minimizing potential hazards and removing dangerous objects. Implement sensory integration techniques, such as deep pressure or fidget toys, to reduce self-stimulatory behaviors that may lead to injury. Educate the patient’s family and caregivers on strategies to prevent accidents and provide supervision when necessary.

41. Impaired Verbal Communication: Use visual supports (e.g., picture cards, and communication boards) to facilitate communication and reduce frustration. Employ alternative communication methods, such as sign language or augmentative and alternative communication devices, if verbal communication is limited. Encourage the patient’s active participation in speech therapy sessions to improve language skills and increase verbal expression. Disturbed Sleep Pattern: Create a calming bedtime routine, ensuring a quiet and comfortable sleep environment. Educate the patient’s family on sensory integration techniques, relaxation strategies, and sleep hygiene practices. Collaborate with the healthcare team to assess and address any underlying medical conditions affecting sleep, such as sleep apnea or gastrointestinal issues.

42. Evaluation & Outcome Improved social interactions and increased participation in social activities. Reduced incidence of injuries resulting from self-stimulatory behaviors. Enhanced communication skills, including increased verbal expression or effective use of alternative communication methods. Improved sleep patterns and increased restful sleep duration.

43. Atypical Autism Atypical autism, also known as pervasive developmental disorder not otherwise specified (PDD-NOS), is a type of autism spectrum disorder (ASD) that is characterized by mild to moderate symptoms of autism. It is considered atypical because it does not fit the criteria for classic autism or Asperger's syndrome. 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 individual.

44. Asperger’s Syndrome Asperger's syndrome (sometimes called high-functioning autism) is part of a wide diagnosis called autism spectrum disorder (ASD). Since 2013, Asperger’s syndrome is replaced by the broader diagnosis of ASD within the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) revised criteria. People with ASD have difficulty with socializing and social skills. They tend to have narrow range of interests, rigid routines and will often show repetitive behavior (such as flapping their hands).

45. Behavioral and Emotional Disorders with onset usually occurring in childhood and adolescence Hyperkinetic Disorder: Hyperkinetic disorders are characterized by abnormal involuntary movement. These excess movements can be regular and rhythmic, as in tremor; more sustained and patterned, as in dystonia; brief and random, as in chorea; or jerk-like and temporarily suppressible, as in tics. Diagnosis of the specific condition depends primarily upon careful observation of the clinical features. Tics are the most common hyperkinetic disorder in children. Dystonia, stereotypies, choreoathetosis, tremors, and myoclonus also occur but are less common. Many hyperkinetic movement disorders manifest with multiple types of movements, which may include a combination of the various hyperkinesias. This syndrome was diagnosed by Heinrich Hoff in 1854.

46. Characteristics of ADHD Being unable to sit still, especially in calm or quiet surroundings. Constantly fidgeting. Being unable to concentrate on tasks. Excessive physical movement. Excessive talking. Being unable to wait their turn. Acting without thinking. Interrupting conversations. Epidemiology: A prevalence of 1.7 percent was found among primary school children. ADHD is four times more common in boys than girls .

47. Etiology Biological Influence Biochemical theory Pre, peri & postnatal factors There is greater concordance in monozygotic than in dizygotic twins. Siblings with hyperactivity Biological parents of children have a higher incidence of ADHD than do adoptive parents A deficit of dopamine and norepinephrine has been attributed in the over activity seen in ADHD. This deficit of neurotransmitter is believed to lower the threshold for stimuli input. Prenatal toxic exposure, prenatal mechanical insult to the fetal nervous system. Prematurity fetal distress, precipitated or prolonged labor, perinatal asphyxia and low Apgar score. Post natal infection, CNS abnormalities resulting from trauma

48. Environmental Influence Psychosocial Factors Environmental lead Food additives, coloring preservatives and sugar have also been suggested as possible cause of hyperactive behavior but there is no definite evidence Prolonged emotional deprivation Stressful psychic events Disruptions of family equilibrium

49. Risk factors of ADHD Drug exposure in utero Birth complication Low birth weight Lead poisoning

50. Predominantly inattentive presentation Trouble paying attention to details or making careless mistakes. Issues remaining focused on tasks and activities. Difficulty listening well, daydreaming or seeming distracted. Trouble with following instructions and/or finishing tasks. Difficulty with organizing tasks and activities. Avoiding or disliking tasks that require continuous mental effort. Losing things frequently. Easily distracted by outside stimuli. Forgetful in daily activities.

51. Predominantly hyperactive/impulsive presentation Fidgeting with or tapping hands or feet or squirming frequently. Leaving their seat when remaining seated is expected. Running or climbing when it’s not appropriate. Trouble playing or engaging in leisure activities quietly. Always seeming “on the go” or “driven by a motor.” Talking too much. Blurting out answers before questions are completed. Frequent trouble waiting for their turn. Often interrupting or intruding on others’ conversations or games.

52. Combined presentation People with combined type display behaviors from both the inattentive and hyperactive/impulsive categories. According to the DSM-5, children must display at least 12 of the total behaviors (at least six inattentive behaviors and six hyperactive/impulsive behaviors).

53. Diagnosis Medical exam, to help rule out other possible causes of symptoms. Information gathering, such as any current medical issues, personal and family medical history, and school records. Interviews or questionnaires for family members, your child's teachers or other people who know your child well, such as caregivers, babysitters and coaches. ADHD criteria from the Diagnostic and Statistical Manual of Mental Disorders DSM-5, published by the American Psychiatric Association. ADHD rating scales to help collect and evaluate information about your child.

54. Treatment Standard treatments for ADHD in children include medications, behavior therapy, counseling and education services. These treatments can relieve many of the symptoms of ADHD, but they don't cure it. It may take some time to determine what works best for your child. Pharmacotherapy CNS stimulants: Dextroamphetamine, Methyphenidate,Pemoline Tricyclic Antidepressant: Imipramine and Nortriptyline 3.5 to 4.6 mg/kg/day Antipsychotics: Risperidone or Olanzapine 16 mg/day-is 6.3 mg/day SSRI: Adderall 40 mg per day Clonidine:   0.2 mg to 0.6 mg per day

55. Psychological therapies Cognitive-Behavioral Therapy for ADHD Cognitive-behavioral therapy is generally considered the gold standard for ADHD psychotherapy. While "regular" CBT can be helpful for ADHD, there are also specific types of CBT for ADHD. This can help with improving daily life struggles such as procrastinating, time management struggles, and poor planning. CBT helps people find new coping strategies and the emotions and behaviors that interfere with implementing strategies.  The CBT for ADHD model is organized around three core modules and two optional ones: Psycho-education and organizing/plannin g Coping with distractibility Adaptive thinking

56. Behavior Modification Behavior modification: Positive reinforcement: You might give your child extra screen time when they do their homework directly after school. Negative reinforcement:  In the classroom, you may see teachers reinforcing positive behavior by eliminating a homework assignment when students do well on a test. Positive punishment: A student may be told to stay after school if they’re caught texting during class. Negative punishment: A parent may take away a child’s favorite doll if they won’t share it with a friend or withhold dessert if a child won’t eat all their vegetables at dinner. 

57. Nursing Intervention Diagnosis Related to As evidenced by Expected outcomes Risk for Delayed Development Delayed diagnosis Developmental lag Genetics Prematurity Lead exposure  A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred, and the goal of  nursing interventions  is aimed at prevention. Patient will be able to perform  self-care  and self-control activities appropriate for their age. Patient’s family will verbalize their understanding of the delay/deviation in development and plans for intervention. Patient will demonstrate behavior and social skills appropriate to their age group.

58. Diagnosis Related to As evidenced by Expected outcomes Disturbed Thought Processes Neurological disorder Dopamine imbalance Inability to concentrate Poor decision-making skills Inability to follow instructions Forgetfulness Patient will be able to complete a task without becoming distracted. Patient will display improved control of emotions, concentration, and hyperactivity. Patient will demonstrate appropriate decision-making.

59. Nursing Diagnosis: Related to: As evidenced by: Expected outcomes: Compromised Family Coping Exhaustion of supportive system Incorrect understanding of ADHD Family disorganization or role changes Frequent arguing Defiance Relationship problems Increased conflict Patient and their family will interact appropriately with each other, providing support and assistance as indicated. Patient and their family will verbalize knowledge and understanding of the condition. Patient’s family will verbalize resources available for the client and themselves.

60. Conduct Disorder Conduct disorder refers to a group of behavioral and emotional problems characterized by a disregard for others. Children with conduct disorder have a difficult time following rules and behaving in a socially acceptable way. Their behavior can be hostile and sometimes physically violent. The onset occurs much before 18 years of age, usually even before puberty. The disorder is much more common in boys.

61. Biological:  Some studies suggest that defects or injuries to certain areas of the brain can lead to behavior disorders. Conduct disorder has been linked to particular brain regions involved in regulating behavior, impulse control, and emotion. Conduct disorder symptoms may occur if nerve cell circuits along these brain regions do not work properly. Further, many children and teens with conduct disorder also have other mental illnesses, such as attention-deficit/hyperactivity disorder (ADHD), learning disorders, depression, substance abuse, or an anxiety disorder, which may contribute to the symptoms of conduct disorder. Genetics:  Many children and teens with conduct disorder have close family members with mental illnesses, including mood disorders, anxiety disorders, substance use disorders and personality disorders. This suggests that a vulnerability to conduct disorder may be at least partially inherited.

62. Environmental:  Factors such as a dysfunctional family life, childhood abuse, traumatic experiences, a family history of substance abuse, and inconsistent discipline by parents may contribute to the development of conduct disorder. Psychological : Some experts believe that conduct disorders can reflect problems with moral awareness (notably, lack of guilt and remorse) and deficits in cognitive processing. Social:  Low socioeconomic status and not being accepted by their peers appear to be risk factors for the development of conduct disorder.

63. Clinical Features Aggression or serious threats of harm to people or animals; Deliberate property damage or destruction (e.g., fire setting, vandalism); Repeated violation of household or school rules, laws, or both; and Persistent lying to avoid consequences or to obtain tangible goods or privileges Cruelty towards other people and animals Physical violence like rape, assaultive behavior, use of weapons etc In addition to the typical symptoms of conduct disorder, secondary complication often develops like, drug abuse and dependence.

64. Diagnosis Complete team approach is important because antisocial behavior tend to be underreported. Educational assessment to determine if there are cognitive deficits, learning disabilities, or problem in intellectual functioning. A neurologic examination if there’s a history of head trauma or seizures.

65. Treatment modalities Cognitive-behavioral therapy.  A child learns how to better solve problems, communicate, and handle stress. He or she also learns how to control impulses and anger. Family therapy.  This therapy helps make changes in the family. It improves communication skills and family interactions. Peer group therapy.  A child develops better social and interpersonal skills. Medicines.  These are not often used to treat conduct disorder. But a child may need them for other symptoms or disorders, such as ADHD.

66. Nursing Intervention Nursing Diagnosis Risk for other-directed violence related to aggression to other people or animals. Noncompliance related to resentment of those in authority. Ineffective coping related to low self-esteem. Impaired social interaction related to hostility towards those in authority. Chronic low self esteem related to lack of value to self.

67. Nursing Care Planning and Goals Treatment outcomes for clients with conduct disorders may include the following: The client will not hurt others or damage property. The client will participate in treatment. The client will effective problem-solving and coping skills. The client will use age-appropriate and acceptable behaviors when interacting with others. The client will verbalize positive, age-appropriate statements about self.

68. Nursing Intervention Decreasing violence and increasing compliance with treatment.  The nurse must set limits on unacceptable behavior at the beginning of treatment; for limit setting to be effective, the consequences must have meaning for the clients- that is, they must value or desire recreation time. Improving coping skills and self-esteem.  The nurse must show acceptance of clients as worthwhile persons even if their behavior is unacceptable; this means that the nurse must be matter-of-fact about setting limits and must not make judgmental statements about clients. Promoting social interaction.  The nurse identifies what is not appropriate, such as profanity and name-calling, and also what is appropriate; positive feedback is essential to let clients know they are meeting expectations. Providing client and family interaction.  The nurse can teach parents age-appropriate activities and expectations for clients such as reasonable curfews, household responsibilities, and acceptable behavior at home.

69. Evaluation Goals are met as evidenced by: The client was able to not hurt others or damage property. The client was able to participate in treatment. The client was able to effective problem-solving and coping skills. The client was able to use age-appropriate and acceptable behaviors when interacting with others. The client was able to verbalize positive, age-appropriate statements about self.

70. Juvenile Delinquency Juvenile Delinquency is the involvement of a kid who is between the age of 10 and 17 in illegal activity or behaviour . Adolescent misconduct is likewise used to allude to youngsters who display constant conduct of underhandedness or noncompliance, in order to be considered out of parental control, getting to be plainly subject to legitimate activity by the court framework. Juvenile delinquency is also known as “juvenile offending,” and each state has a separate legal system in place to deal with juveniles who break the law. The term ‘delinquency’ is derived from the Latin word  ‘ delinquer ’ , which means ‘omit’. Juvenile delinquency refers to the disapproved behaviour of children and adolescents, where they tend to show criminal behaviour . In simple terms, it means deviance from the approved norms and laws in society, where children usually indulge in anti-social activities. 

71. Causes of Delinquency Juvenile Delinquency has become a serious concern for the world and persists in every country across the globe. To deal with this issue, it is very important to understand the fundamental causes and reasons of Juvenile Delinquency. Family Issues:  Family is the first place where a child is most attached. Children generally learn from what they observe around them. If there are continuous fights in the family, it will affect a child’s growth and development mentally, physically, and emotionally, and that will eventually lead to juvenile delinquency. Changing Patterns in Lifestyle:  This is another reason for criminal behavior in children. They are confronted mostly with the issue of the generation gap due to which they usually detach themselves and are incapable of distinguishing between right and wrong. Apparently, they are misguided and then end up choosing the evil path.

72. Biological Factors:  Factors, like lack of understanding, low intelligence, etc., also lead to delinquent behavior among children. Here, the role of parents, teachers and elders comes into the picture that they must educate their children regarding the biological differences between a male and a female and answer their questions regarding other biological processes and consequences of any illegal act. Poverty : When a child is not provided with basic necessities of life, there is a high probability that the child may indulge in delinquent acts to get those necessities. Failure to provide them with amenities like food, shelter, clothing, etc., can force them to earn money by any means in order to get what they desire. Substance Abuse : Being exposed to substances leads to dependence over time, and these individuals end up committing crimes that they wouldn’t have thought otherwise. In such cases, children need counselling to help them regain their sense of worth and self-esteem. Other Factors:  Other factors, like child labor, traumatic experiences, illiteracy, unsoundness of mind etc., are also responsible for juvenile’s delinquent behavior.

73. Reformatory measures The Reformatory School Act, 1876 was enacted to transform the attitude of juveniles and provide reformatory provisions relating to juvenile offenders. The Court can direct delinquents below the age of sixteen who have been sentenced to imprisonment to attend the reformatory school instead of sending them to prison.

74. Separation Anxiety Disorder Separation anxiety is a typical phase for many infants and toddlers. Young children often have a period where they get anxious or distressed when they have to separate from their parent or main caregivers. Examples of this can be tears at daycare drop-off or getting fussy when a new person holds them. This usually starts to improve by about 2 to 3 years of age. In some children, intense and ongoing separation anxiety is a sign of a more serious condition known as separation anxiety disorder. Separation anxiety disorder can be identified as early as preschool age. Less often, separation anxiety disorder can occur in teenagers and adults. This can cause major problems leaving home or going to work. Treatment can lessen separation anxiety disorder symptoms. Treatment may include specific types of therapy, sometimes along with medicine.

75. Your child may have separation anxiety disorder if separation anxiety seems more intense than other kids of the same age or lasts a longer time, interferes with school or other daily activities, or includes panic attacks or other problem behaviors. Most often, separation anxiety relates to the child's anxiety about being away from parents or guardians, but it could relate to another close caregiver.

76. Symptoms Separation anxiety disorder is diagnosed when symptoms are much more than expected for someone's developmental age and cause major distress or problems doing daily activities. Symptoms may include: Repeated and intense distress when thinking about separation or when away from home or loved ones. This may include being clingy or having tantrums about separation that last longer or are more severe than other kids of the same age. Constant, intense worry about losing a parent or other loved one to an illness, death, or a disaster or harm coming to them. Constant worry that something bad will happen, such as being lost or kidnapped, causing separation from parents or other loved ones. Not wanting to or refusing to be away from home because of fear of separation.

77. Not wanting to be home alone or somewhere without a parent or other loved one close by, if the child has reached an age where being alone might be expected. Not wanting to or refusing to sleep away from home or to go to sleep without a parent or other loved one nearby, if the child has reached an age where these activities might be expected. Repeated nightmares about separation. Repeated complaints of headaches, stomachaches, or other symptoms during or before separation from a parent or other loved one. Separation anxiety disorder may occur along with panic attacks. Panic attacks are repeated bouts of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes.

78. Treatment Separation anxiety disorder is usually treated first with psychotherapy. Sometimes medicine also is used if therapy alone isn't working. Psychotherapy involves working with a trained therapist to lessen separation anxiety symptoms. Psychotherapy Cognitive behavioral therapy (CBT) is an effective form of therapy for separation anxiety disorder. Exposure treatment, a part of CBT, has been found to be helpful for separation anxiety. During this type of treatment your child can learn how to face and manage fears about separation and uncertainty. Also, parents can learn how to effectively give emotional support and encourage independence that suits the child's age.

79. Medicine Sometimes, combining medicine with CBT may be helpful if anxiety symptoms are severe and a child isn't making progress in therapy alone. Antidepressants called selective serotonin reuptake inhibitors (SSRIs) may be an option for older children and adults.

80. Phobic Anxiety Disorder Social Anxiety Disorder Siblings Rivalry Disorder Elective Mutism

81. Tic Disorder Tics are irregular, uncontrollable, and repetitive movements of muscles that can occur in any part of the body. Types of tic disorders include motor, vocal, and Tourette’s syndrome. Movements of the limbs and other body parts are known as motor tics. Involuntary repetitive sounds, such as grunting, sniffing, or throat clearing, are called vocal tics. Tic disorders usually start in childhood, first presenting at approximately 5 years of age. In general, they are more common among malesTrusted Source compared with females. Many cases of tics are temporary and resolve within a year. However, some people who experience tics develop a chronic disorder. Chronic tics affects about 1 out of 100.

82. Types of tics disorders Tic disorders can usually be classified Trusted Source as motor, vocal, or Tourette’s syndrome, which is a combination of both. Motor and vocal tics can be short-lived (transient) or chronic. Tourette’s is considered to be a chronic tic disorder. According to the American Academy of Child and Adolescent Psychiatry, transient tic disorder or provisional tic disorder affects up to 10 percent of children during their early school years. Children with transient tic disorder will present with one or more tics for at least 1 month, but for less than 12 consecutive months. The onset of the tics must have been before the individual turned 18 years of age. Motor tics are more commonly seen in cases of transient tic disorder than vocal tics. Tics may vary in type and severity over time. Some research Trusted Source suggests that tics are more common among children with learning disabilities and are seen more in special education classrooms. Children within the autism spectrum are also more likely to have tics.

83. Chronic motor or vocal tic disorder Tics that appear before the age of 18 and last for 1 year or more may be classified as a chronic tic disorder. These tics can be either motor or vocal, but not both. Chronic tic disorder is less common than transient tic disorder, with less than 1 percent of children affected. If the child is younger at the onset of a chronic motor or vocal tic disorder, they have a greater chance of recovery, with tics usually disappearing within 6 years. People who continue to experience symptoms beyond age 18 are less likely to see their symptoms resolved.

84. Tourette’s syndrome Tourette’s syndrome (TS) is a complex neurological disorder. It is characterized by multiple tics – both motor and vocal. It is the most severe and least common tic disorder. The Centers for Disease Control and Prevention (CDC)Trusted Source report that the exact number of people with TS is unknown. CDC research suggests that half of all children with the condition are not diagnosed. Currently, 0.3 percent of children aged 6 to 17 in the United States have been diagnosed with TS. Symptoms of TS vary in their severity over time. For many people, symptoms improve with age. TS is often accompanied by other conditions, such as attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD).

85. Symptoms The defining symptom of tic disorders is the presence of one or more tics. These tics can be classified as: Motor tics : These include tics, such as head and shoulder movements, blinking, jerking, banging, clicking fingers, or touching things or other people. Motor tics tend to appear before vocal tics, although this is not always the case. Vocal tics : These are sounds, such as coughing, throat clearing or grunting, or repeating words or phrases. Tics can also be divided into the following categories: Simple tics : These are sudden and fleeting tics using few muscle groups. Examples include nose twitching, eye darting, or throat clearing. Complex tics : These involve coordinated movements using several muscle groups. Examples include hopping or stepping in a certain way, gesturing, or repeating words or phrases. Tics are usually preceded by an uncomfortable urge, such as an itch or tingle. While it is possible to hold back from carrying out the tic, this requires a great deal of effort and often causes tension and stress. Relief from these sensations is experienced upon carrying out the tic.

86. The exact cause of tic disorders is unknown. Within Tourette’s research, recent studies have identified some specific gene mutations that may have a role. Brain chemistry also seems to be important, especially the brain chemicals glutamate, serotonin, and dopamine. Tics that have a direct cause fit into a different category of diagnosis. These include tics due to: Head injuries Stroke Infections Poisons Surgery Other injuries

87. Etiology Changes (mutations) in one or more genes have been shown to be involved with TS. A small number of people with TS have mutations involving the SLITRK1 gene, which affects how neurons grow and connect with one another. Abnormalities in the NRXN1 and CNTN6 genes, which also regulate the normal formation of these nerve connections, also may play a role in TS . Most cases of TS involve the interaction of multiple gene variations and environmental factors.    Although the cause of TS is unknown, current research points to abnormalities in: Certain brain regions, including the basal ganglia, frontal lobes, and cortex Circuits that connect these regions Neurotransmitters (dopamine, serotonin, and norepinephrine) responsible for communication between nerve cells (neurons)

88. Treatment Medications that block dopamine (drugs that may be used to treat psychotic and non-psychotic disorders) are the most consistently useful medications to suppress tics (for example, haloperidol and pimozide ).Alpha-adrenergic agonists such as clonidine and guanfacine are used primarily for hypertension (high blood pressure) but are also used to treat tics. Stimulant medications such as methylphenidate and dextroamphetamine can lessen ADHD symptoms in people with TS without causing tics to become more severe. Some studies show the short-term use of these drugs can help children with TS who also have ADHD.Antidepressants , specifically,   serotonin reuptake inhibitors ( clomipramine , fluoxetine , fluvoxamine , paroxetine , and sertraline ) can help some people control symptoms of depression, OCD, and anxiety.

89. Pica Pica is an eating disorder in which a person eats things not usually considered food. Young kids often put non-food items (like grass or toys) in their mouths because they're curious about the world around them. But kids with pica go beyond that .

90. Stereotyped movements Disorders Stereotypic movement disorder is a condition in which a person makes repetitive, purposeless movements. These can be hand waving, body rocking, or head banging. The movements interfere with normal activity or may cause bodily harm . Causes Stereotypic movement disorder is more common among boys than girls. The movements often increase with stress, frustration, and boredom. The cause of this disorder, when it doesn't occur with other conditions, is unknown. Stimulant drugs such as cocaine and amphetamines can cause a severe, short period of movement behavior. This may include picking, hand wringing, head tics, or lip-biting. Long-term stimulant use may lead to longer periods of the behavior. Head injuries may also cause stereotypic movements.

91. Symptoms Symptoms of this disorder may include any of the following movements: Biting self Hand shaking or waving Head banging Hitting own body Mouthing of objects Nail biting Rocking Exams and Tests Your health care provider can usually diagnose this condition with a physical exam. Tests should be done to rule out other causes including: Autism spectrum disorder Chorea disorders Obsessive-compulsive disorder (OCD) Tourette syndrome or other tic disorder

92. Treatment Treatment should focus on the cause, specific symptoms, and the person's age. The environment should be changed so that it is safer for people who may injure themselves. Behavioral techniques and psychotherapy may be helpful. Medicines may also help reduce symptoms related to this condition. Antidepressants have been used in some cases.

93. Stuttering Stuttering is a condition that happens when muscles you use for speaking twitch or move uncontrollably while you talk. This disrupts the flow of your speech and causes pauses, unintended sounds and sticking on words. This condition usually affects children but can have impacts at any age. It’s treatable, and most people ultimately recover . Stuttering is a speech disorder that affects the rhythm and flow of how you talk. This disorder disrupts how you speak, causing unintended sounds, pauses or other problems with talking smoothly .

94. There are a few different subtypes of stuttering : Developmental stuttering (child-onset fluency disorder) . This is a neuro -developmental disorder, meaning it happens because your brain develops differently than expected. This form starts when you’re a child. Persistent stuttering . This is developmental stuttering that continues into adulthood. Acquired stuttering . This is stuttering you develop because of an illness or injury that affects your brain.

95. Follow-up Here is some valuable advice from mental health professionals on improving a child’s mental state focusing on early detection, personalized care, family involvement, and holistic development strategies. Early Detection and Intervention The earlier a mental health condition is identified and addressed, the better the outcome. Regular screenings and monitoring for signs of mental health disorders are crucial. Creating a Supportive Environment Children thrive in a supportive and understanding environment. Homes and schools should be safe spaces where children feel valued and heard. Individualised Treatment Plans Every child is unique, and so are their needs. Personalized treatment plans, tailored to each child’s specific condition and circumstances, are essential for effective treatment. Integrating Therapy and Medication In many cases, a combination of therapy and medication may be necessary. Cognitive Behavioral Therapy (CBT), play therapy, and family therapy are common therapeutic approaches. Involving Family in Treatment Family involvement is crucial in children’s treatment. Educating families about the child’s condition and how to provide support is key to successful treatment .

96. Focus on Holistic Development Treatment should not only focus on alleviating symptoms but also on supporting the child’s overall development, including social skills, academic performance, and self-esteem. Consistent Monitoring and Follow-Up Ongoing assessment of the child’s progress and adjustment of treatment plans as needed are crucial for long-term success. Addressing Stigma Combatting the stigma surrounding emotional health is vital. Awareness programs and education can help normalize mental health issues and encourage open discussion. Collaborative Approach A multidisciplinary approach involving psychiatrists, psychologists, educators, and other professionals can provide comprehensive care and better outcomes. Promoting Awareness Educating children about this subject from a young age can foster resilience and help them develop coping mechanisms.