CHILD AND ADOLESCENT PSYCHIATRIC NURSING

KEY TERMS
Attention-deficit hyperactivity disorder (ADHD) Relatively common disorder of childhood
onset characterized by inattention, impulsiveness, and overactivity
Child abuse Harmful physical, emotional, and/ or sexual acts inflicted on a child
Epidemiology The study of the frequency and distribution of disease conditions in the population
Family System A field of influence exerted on each family member due to the complex interaction
of all family members
Genetic vulnerability Inherited liability that increases the risk of manifesting a psychiatric disorder
Pervasive developmental disorder (PDD) Any one of the several conditions that are characterized by
multiple social and cognitive delays
Prevalence Estimate of the frequency of a disease condition in the population, e.g., ADHD affects 5-11%
of the school-aged children
Psychosocial adversity Environmental conditions such as poverty, unemployment, or overcrowded living
conditions that do not support optimal development of the child
Resilience Capacity to move forward with development despite psychosocial adversity or genetic
vulnerability.

SCOPE OF THE PROBLEM

10%-13% of school-aged children have persistent and serious mental health problems;
another 15%-20% have milder problems with interpersonal relationships and adjustment
to school
Epidemiology of Child Psychiatric Disorders
Genetic Factors- With genetic component are depression, anxiety disorders, tic disorders, and
ADHD, having a close family member with that disorder may be the single largest contributor to
the likelihood of the disorder in the child. While those with fragile X syndrome ( which is the
second most common genetic form of mental retardation) are one of the biological risk factors. If
a disorder is genetically inherited, it implies that the action of one or more genes is abnormal.
The types of inheritance are the following:
Autosomal dominant One parent is affected with the disorder and passes on a single copy of the disease-
causing gene to the affected offspring. Eg. Huntington’s chorea
Autosomal Recessive Each unaffected parent passes on one disease-causing gene to the affected
offspring. Eg. Phenylketonuria
Sex-Linked Inheritance Recalling that women have an XX karyotype and men have an XY karyotype, it
is possible for another to carry a trait on one X chromosome without being affected. Eg. Some forms of
hemophilia
Polygenetic inheritance These disorders are presumed to be caused by several genes acting in
combination. Eg. Schizophrenia and some forms of learning disability of
Environmental Factors- these are any and all nongenetic exposures, including intrauterine insults,
adverse family conditions, poverty, unsupportive community circumstances, natural disasters, traumatic
events and toxic substances
Psychosocial adversity Poverty, family discord, overcrowded living conditions, sexual abuse, physical
abuse, and a parent with a history of substance abuse or a psychiatric disorder are associated with
psychiatric disorders in children and adolescents.
DEVELOPMENTAL DISORDERS
Mental Retardation ( Intellectual Developmental Disorder) is defined by sub average intelligence (IQ
below 70) that is accompanied by impairments in performing age-expected activities in daily living. The
Classification is:
Mild IQ of 55-69
Moderate IQ of 40-54
Severe IQ of 25-39
Profound IQ below 25
Deficits in Intellectual Functioning: Reasoning, problem-solving, planning, abstract thinking,
judgement, academic learning, experiential learning

Pervasive Developmental Disorders are a group of disorders characterized by severe impairments across
multiple domains of development. The disorder under these are Autistic disorders, Aspergers’ disorder,
PDD- not otherwise specified. General characteristics of PDD includes: delayed socialization and
communication, and stereotypical behaviors, such as rocking, hand flapping, and peculiar preoccupations.
Children are rigid, tend to perseverate on themes of idiosyncratic interest, are intolerant of change in
routines, and are prone to behavioral outburst.
1. Autistic Disorder/Autism Spectrum Disorders- 1st described by Leo Kanner 50 years ago. It
can be differentiated with other forms of PDD because it has an early age of onset (before 30
months of age), social relatedness is profoundly disturbed, and the delayed developmental
profile is relatively constant; they also appear aloof, indifferent to others, seem to prefer
inanimate objects to human contact. Language is both delayed and deviant, being characterized
by abnormal intonation, pronoun reversal, and echolalia.
2. Asperger’s Disorder- in DSM5, it is considered to be under Autism Spectrum Disorders
3. Pervasive Developmental Disorder—not otherwise specified (PDD-NOS)- This is a residual
category reserved for children who do not meet criteria for a more specific type of PDD such
as autism or Aspergers’. In general, features are less severe in PDD-NOS than in autism.

Specific Developmental Disorders

1. LEARNING DISORDER. DYSLEXIA- The most common type of learning disorder is reading
disability
2. COMMUNICATION DISORDERS. SPEECH AND LANGUAGE

Disruptive Behavioral Disorders

1. Attention-Deficit Hyperactivity Disorder- characterized by inattention, impulsiveness, and
overactivity. Classically, children with ADHD are restless, overactive, distractible, reckless,
and disruptive. Although the etiology remains unknown, a growing body of evidence suggests
that subtle dysfunction in the frontal lobe plays an essential role in the core symptoms of
ADHD. Inattention and hyperactivity should be at least 6 months and are maladaptive. Patients
maybe inattentive to details, forgetful in daily chores, can’t organize task, avoid mental effort,
often loses things, fidgety, restless, can’t wait in line, inappropriately leaves seat,
inappropriately runs or climb, difficulty playing, blurts out answers to question etc. (Drugs for
ADHD: Ritalin (Methylphenidate), Adderall(Amphetamine) and
Dexedrine(Dextroamphetamine))
 2. Oppositional Defiant Disorder is defined by an enduring pattern of disobedience,
argumentativeness, explosive angry outburst, low frustration tolerance, and tendency to blame
others for quarrels or accidents by children. Often caused by a combination of biological,
psychological and social factors. Tends to occur in ADHD, substance use disorders or mood
disorders.

3. Conduct Disorder is characterized by more serious violations of social standards such as

aggression, vandalism, cruelty to animals, stealing, lying and truancy (absenteeism/loitering).
Child or adolescent exhibits these behavior patterns in a variety of settings and cause
significant impairment in social, family and academic functioning. Many youth with conduct
disorder may have trouble expressing empathy or remorse and reading social cues. They often
misinterpret the actions of others as being hostile and aggressive and respond by escalating the
situation into conflict. It may also be associated with substance abuse, risk taking behavior and
physical injury.
a. Aggressive behavior that threatens harm to other people and animals, often initiating fights
or being physically cruel to animals.
b. Non-aggressive conduct that causes property loss and damage such as fire-setting and
deliberate destruction of others property
c. Deceitfulness or theft, lying and conning others
d. Serious rule violations such as staying out at night when prohibited, running away from
home, truancy from school