Childhood Disorders

Knowing which will steer you towards proper treatment. 

• Maps predictable course by identifying stages that occur in linear fashion
• Tasks must be mastered before child moves to next level
• The mastery of these tasks gives the child a sense of control over himself and his environment
• Regression may occur at any time of a maturational achievement
• Regression may occur during stress

• Establishing closeness and trusting relationships……INFANCY
• Handling separation and independent decision making…..TODDLERHOOD
• Negotiating joint decisions and interpersonal conflict…..PRESCHOOL
• Dealing with frustration and unfavorable events…..MIDDLE CHILDHOOD
• Celebrating good feelings and experiencing pleasure…MIDDLE CHILDHOOD
• Working with delayed gratification..EARLY A
• Relaxing and playing….EARLY ADOLESCENCE
• Cognitive processing through words, symbols and images…..LATER ADOLESCENCE
• Establishing an adaptive sense of direction and purpose…..LATER ADOLESCENCE

• Distress when separated from parent and home
• School refusal- use of transitional object
• Pervasive worry and fearfulness
• Restlessness and irritability
• Phobias
• Somatic complaints
• Restless sleep and nightmares (big one with kids). 
• Repetitive play of stressful events

• Cognitive behavioral therapy
• Treat parental anxiety
• Drug therapy in conjunction with psychotherapy
• Relaxation and imagery

• Persistent depressed mood, unhappiness  and irritability
• Loss of interest in friends and play
• Loss of energy
• Deterioration in school work
• Loss of appetite and no weight gain
• Sleep disturbance
• Somatic complaints
• Suicidal ideation, worthlessness

• Cognitive behavioral therapy
• Family therapy
• Antidepressant drug therapy (Prozac)
• Play therapy
• Assess and deal with suicidality

• Hyperactive does not start till age of 5 or 6
• Easily distracted
• Interrupts others
• Doesn’t need much sleep or sleeps too much
• Some same symptoms as adults
• Treated with mood stabilizers like with adults

• Mood stabilizers
• Antipsychotics
• Structure and predictability in the environment
• Reinforce positive behaviors
• Use simple clear instructions: One step at a time
• Use notes and lists to assist memory, back packs
• Discuss daily expectations : checklist with rewards
• Set up schedule

• Difficulty in attending to details,mistakes
• Difficulty in tasks/play
• Not seeming to listen
• Failure to follow through on instructions
• Difficulty in organizing
• Loss of items
• Distractible and forgetful in daily activities
• Significant impairment in two or more settings

• Fidgeting hands/feet
• Leaving seat
• Running around or climbing excessively
• Difficulty in quiet activities
• “on the go”,  “driven by a motor”
• Often talking excessively
• Blurting, interrupting and difficulty WAITING

• Structure and predictability in the environment
• Encourage child to slow down
• Reinforce positive behaviors
• Use simple clear instructions: One step at a time
• Use notes and lists to assist memory, back packs
• Discuss daily expectations: checklist with rewards
• Set up schedule
• Medication: Stimulants and nonstimulants

• Recurrent pattern of negativistic, defiant, disobedient and hostile behavior toward AUTHORITY FIGURES
• Blames others for his mistakes
• Easily annoyed, angry and resentful
• Unwilling to compromise, tests limits, often verbally aggressive
• Not to be confused with "normal" adolescent behavior.

• Provide consistent rules with logical consequences
• Help child identify anger
• Find appropriate ways to express anger
• Teach social skills
• *Withdraw from social group
• Role play to get child in touch with others’ feelings

• Repetitive and persistent pattern of behavior where child violates the basic rights of others or major social norms or rules.
• Antisocial behavior:physical violence against others, steals, fire setting, cruelty to animals, bullies others, threatens others, forced sexual behavior, vandalism and truancy, runaway
• After adolescence, this behavior may fall into antisocial personality disorder.

• Provide Limits
• Help child accept responsibility for his behavior
• Consistent rules,expectations and consequences
• Deescalate aggressive episodes
• Major tranquilizers may be used to manage aggressive behavior

• Traumatic event(s)
• Symptoms: increased arousal, anxiety, hypervigilance, irritability, physiological hyperactivity, impulsivity, sleep disturbance (somewhat similar to adults)
• Intensity of symptoms: trauma, threat to body integrity, sense of security and family system
• Trauma induced brain response

• Cognitive behavioral therapy
• Treat parental anxiety
• Drug therapy in conjunction with psychotherapy
• Relaxation and imagery
• Be careful about retelling and re-traumatizing
• Work with educated therapists

• Respond warmly to positive behaviors and ignore negative behaviors when possible
• Avoid yelling and commanding 
• Use of time out for negative behaviors
• Establish reasonable expectations
• Communicate often in the child’s language

• Optimistic style
• Good sense of humor
• Strong social skills
• Cognitive competence
• Good  natured temperament
• Perseverance
• Involvement in creative activities
• Strong problem solving skills
• Good management of emotions
• Sense of self awareness

• Caring and supportive parents
• Strong parent-child relationships
• Low levels of family conflict
• Optimistic parenting styles

Three categories of medications: stimulants, nonstims, and combos. 

• Ritalin/Methylphenidate (Stimulant)
• Dexidrine/dextroamphetamine (Stimulant)
• Combination medications
• Nonstimulants

Also review the medication handout posted 

• Mechanism:
• Affects norepinephrine & dopamine
• Stimulates the control centers of the brain 

Side effects:  nervousness, insomnia, tachycardia, hypertension, arrhythmias, weight loss, etc

• Nursing implications: 
• --Teach patient/family not to use caffeine
• --Monitor weight
• --Take in the morning to not interfere with sleep
• --Can stop medication without tapering

• Mechanism:
• Affects norepinephrine and dopamine
• Stimulates the control centers of the brain

Side effects:  restlessness, insomnia, weight loss, overstimulation, tachycardia, hypertension, arrhythmias, tremor, weight loss, etc

• Nursing Implications: 
• --Teach patient/family not to use caffeine
• --Take in the morning to not interfere with sleep
• --Monitor weight
• --Can stop medication without tapering

Amphetamine: dextramphetamine saccharate with dextroamphetamine sulfate

Similar actions, side effects and nursing implications to dexidrine/dextroamphetamine

Mechanism:  Norepinephrine re-uptake inhibitor (SNRI)

Side effects:  Headache, insomnia, decreased appetite, abdominal pain, constipation, dry mouth, cough, increased sweating, dermatitis

Nursing implications: 

• Monitor growth of child
• --Can stunt growth
• --If weight unsatisfactory, consider changing medication
• --Monitor blood pressure and pulse
• --Can stop medication without tapering