Behavioral/Psychiatric Disorders of Adolescents and
Children
Introduction
• It is often difficult to determine whether a child’s behavior
indicates emotional problems
• This chapter examines various disorders in which the symptoms
usually first
become evident during infancy, childhood, or adolescence.
• All nurses working with children or adolescents should be
knowledgeable about normal stages of growth and
development.
• Guidelines for making a determination if a behavior constitutes
emotional
problems should consider appropriateness of the behavior regarding
age, cultural norms, and whether the behavior interferes with
adaptive functioning
• An emotional problem exists if behavioral manifestations
o Are not age appropriate
o Deviate from cultural norms
o Interfere with adaptive functioning
• This chapter focuses on the nursing process in care of clients with
intellectual disability, autism spectrum disorder, attention deficit/
hyperactivity disorder, conduct disorder, oppositional defiant
disorder, Tourette’s disorder, and separation anxiety disorder.
Intellectual Development Disorder
• Intellectual development disorder (IDD) has its onset prior to
age 18 years and is characterized by impairments in measured
intellectual performance and adaptive skills across multiple
domains.
• The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-
5) defines intellectual disability as a “disorder with onset during
developmental period that includes both intellectual and adaptive
functioning deficits in conceptual, social, and practical domains”
o Conceptual = Cognitive/ educational capabilities
o Social = Social/ communication capabilities
o Practical = Psychomotor capabilities
• The incidence rate in the general population is about 1%, and
age of onset occurs during the developmental period. The level
of severity is based on adaptive functioning within the three
domains
• General intellectual functioning: is measured by both clinical assessment
and
a person’s performance on intelligence quotient (IQ) tests.
• Adaptive functioning: refers to the person’s ability to adapt to
requirements of activities of daily living and the expectation of
his or her age and cultural group.
Predisposing Factors to IDD
The etiology of intellectual disability may be primarily biological, primarily
,psychosocial, a combination of both, or in some instances, unknown.
• Genetic factors are implicated as the cause of intellectual disability
in approximately 5% of cases. These factors include:
, o Inborn errors of metabolism
➢ Tay-Sachs disease, Phenylketonuria, Hyperglycinemia
o Chromosomal disorders
➢ Down syndrome, Klinefelter’s syndrome
o Single gene abnormalities
➢ Fragile X syndrome, Tuberous sclerosis, Neurofibromatosis
• Conditions that result in early alterations in embryonic development account
for approximately 30% of intellectual disability cases. Damages may occur
in response to:
o Toxicity associated with maternal ingestion of alcohol or other
drugs
➢ Fetal alcohol syndrome is an example and this disorder
has been identified as one of the leading preventable
causes of intellectual disability.
o Maternal illnesses and infections during pregnancy
➢ Rubella, cytomegalovirus
o Complications of pregnancy
➢ Toxemia, Uncontrolled diabetes
• Circumstances that occur during pregnancy or during the birth process that
result in intellectual disability account for approximately 10% of cases.
Examples include:
o Fetal malnutrition, viral or other infections during pregnancy
o Trauma or complications during delivery that deprive the
infant oxygen
➢ Trauma to the head incurred during the process of birth
➢ Placenta previa
➢ Placenta abruptio (premature separation of the placenta)
➢ Prolapse of the umbilical cord
o Premature birth
• General medical conditions acquired during infancy or childhood account for
approximately 5% of cases of intellectual disability. They include:
o Infections
➢ Meningitis, encephalitis
o Poisonings
➢ Insecticides, medications, lead
o Physical traumas
➢ Head injuries, asphyxiation, hyperpyrexia
• Sociocultural and other mental disorders contribute to 15-20% of cases of
intellectual disability. These include:
➢ Deprivation of nurturance and social stimulation
➢ Impoverished environments associated with poor
prenatal and perinatal care and inadequate nutrition
➢ Severe mental disorders such as autism spectrum
disorder
Application Of The Nursing Process
• Assessment
o The degree of severity of intellectual disability may be
measured by the client’s IQ level. Four levels have been
delineated; mild, moderate, severe, and profound. The levels
are differentiated between the ability
, of the child to perform self-care, cognitive and educational
abilities, social and communication capabilities, and
psychomotor capabilities.
Level (IQ) Ability Cognitive/ Social/ Psychomotor
to Educational Communicati Capabilities
Perform Capabilitie on
Self-care s Capabilities
Activities
Mild Capable of Capable of Capable of Psychomotor
(50- independe academic developing skills usually
70) nt living, skills to social skills. not affected,
with sixth- grade Functions well although may
assistance level. As in a have some
during adult can structured, slight problems
times of achieve sheltered with
stress. vocational setting. coordination.
skills for
minimum
self-
support.
Moderate Can Capable of May experience Motor
perform
(35-49) some academic some development is
skill limitation
activities to second- in speech fair. Vocational
independen grade level. communicatio capabilities may
tl As n.
y. Requires adult may be Difficulty be limited to
supervision. able to adhering to unskilled gross
contribute to social motor activities.
own support convention
in may
sheltered interfere with
workshop. peer
relationships.
Severe May be Unable to Minimal verbal Poor
psychomotor
(20-34) trained in benefit from skills. Wants development.
and
elementary academic or needs often Able to perform
hygiene vocational communicated only simple
tasks
skills. training. by acting out under close
Requires Profits from behaviors. supervision.
complete systematic
supervision.habit
training.
Profound No capacity Unable to Little, if any, Lack of ability
for
(below 20) for profit from speech both fine and
independen academic or development. gross motor
t
functioning. vocational No capacity for movements.
Requires training. May socialization Requires
constant
Children
Introduction
• It is often difficult to determine whether a child’s behavior
indicates emotional problems
• This chapter examines various disorders in which the symptoms
usually first
become evident during infancy, childhood, or adolescence.
• All nurses working with children or adolescents should be
knowledgeable about normal stages of growth and
development.
• Guidelines for making a determination if a behavior constitutes
emotional
problems should consider appropriateness of the behavior regarding
age, cultural norms, and whether the behavior interferes with
adaptive functioning
• An emotional problem exists if behavioral manifestations
o Are not age appropriate
o Deviate from cultural norms
o Interfere with adaptive functioning
• This chapter focuses on the nursing process in care of clients with
intellectual disability, autism spectrum disorder, attention deficit/
hyperactivity disorder, conduct disorder, oppositional defiant
disorder, Tourette’s disorder, and separation anxiety disorder.
Intellectual Development Disorder
• Intellectual development disorder (IDD) has its onset prior to
age 18 years and is characterized by impairments in measured
intellectual performance and adaptive skills across multiple
domains.
• The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-
5) defines intellectual disability as a “disorder with onset during
developmental period that includes both intellectual and adaptive
functioning deficits in conceptual, social, and practical domains”
o Conceptual = Cognitive/ educational capabilities
o Social = Social/ communication capabilities
o Practical = Psychomotor capabilities
• The incidence rate in the general population is about 1%, and
age of onset occurs during the developmental period. The level
of severity is based on adaptive functioning within the three
domains
• General intellectual functioning: is measured by both clinical assessment
and
a person’s performance on intelligence quotient (IQ) tests.
• Adaptive functioning: refers to the person’s ability to adapt to
requirements of activities of daily living and the expectation of
his or her age and cultural group.
Predisposing Factors to IDD
The etiology of intellectual disability may be primarily biological, primarily
,psychosocial, a combination of both, or in some instances, unknown.
• Genetic factors are implicated as the cause of intellectual disability
in approximately 5% of cases. These factors include:
, o Inborn errors of metabolism
➢ Tay-Sachs disease, Phenylketonuria, Hyperglycinemia
o Chromosomal disorders
➢ Down syndrome, Klinefelter’s syndrome
o Single gene abnormalities
➢ Fragile X syndrome, Tuberous sclerosis, Neurofibromatosis
• Conditions that result in early alterations in embryonic development account
for approximately 30% of intellectual disability cases. Damages may occur
in response to:
o Toxicity associated with maternal ingestion of alcohol or other
drugs
➢ Fetal alcohol syndrome is an example and this disorder
has been identified as one of the leading preventable
causes of intellectual disability.
o Maternal illnesses and infections during pregnancy
➢ Rubella, cytomegalovirus
o Complications of pregnancy
➢ Toxemia, Uncontrolled diabetes
• Circumstances that occur during pregnancy or during the birth process that
result in intellectual disability account for approximately 10% of cases.
Examples include:
o Fetal malnutrition, viral or other infections during pregnancy
o Trauma or complications during delivery that deprive the
infant oxygen
➢ Trauma to the head incurred during the process of birth
➢ Placenta previa
➢ Placenta abruptio (premature separation of the placenta)
➢ Prolapse of the umbilical cord
o Premature birth
• General medical conditions acquired during infancy or childhood account for
approximately 5% of cases of intellectual disability. They include:
o Infections
➢ Meningitis, encephalitis
o Poisonings
➢ Insecticides, medications, lead
o Physical traumas
➢ Head injuries, asphyxiation, hyperpyrexia
• Sociocultural and other mental disorders contribute to 15-20% of cases of
intellectual disability. These include:
➢ Deprivation of nurturance and social stimulation
➢ Impoverished environments associated with poor
prenatal and perinatal care and inadequate nutrition
➢ Severe mental disorders such as autism spectrum
disorder
Application Of The Nursing Process
• Assessment
o The degree of severity of intellectual disability may be
measured by the client’s IQ level. Four levels have been
delineated; mild, moderate, severe, and profound. The levels
are differentiated between the ability
, of the child to perform self-care, cognitive and educational
abilities, social and communication capabilities, and
psychomotor capabilities.
Level (IQ) Ability Cognitive/ Social/ Psychomotor
to Educational Communicati Capabilities
Perform Capabilitie on
Self-care s Capabilities
Activities
Mild Capable of Capable of Capable of Psychomotor
(50- independe academic developing skills usually
70) nt living, skills to social skills. not affected,
with sixth- grade Functions well although may
assistance level. As in a have some
during adult can structured, slight problems
times of achieve sheltered with
stress. vocational setting. coordination.
skills for
minimum
self-
support.
Moderate Can Capable of May experience Motor
perform
(35-49) some academic some development is
skill limitation
activities to second- in speech fair. Vocational
independen grade level. communicatio capabilities may
tl As n.
y. Requires adult may be Difficulty be limited to
supervision. able to adhering to unskilled gross
contribute to social motor activities.
own support convention
in may
sheltered interfere with
workshop. peer
relationships.
Severe May be Unable to Minimal verbal Poor
psychomotor
(20-34) trained in benefit from skills. Wants development.
and
elementary academic or needs often Able to perform
hygiene vocational communicated only simple
tasks
skills. training. by acting out under close
Requires Profits from behaviors. supervision.
complete systematic
supervision.habit
training.
Profound No capacity Unable to Little, if any, Lack of ability
for
(below 20) for profit from speech both fine and
independen academic or development. gross motor
t
functioning. vocational No capacity for movements.
Requires training. May socialization Requires
constant
