CHILDHOOD DISORDERS

This module aligns with key elements of APNA’s “Growth & Development” and “Clinical Decision Making” (American Psychiatric Nurses Association Education Council, Undergraduate Branch, 2022).

Module Outline

• Assessment of Childhood Disorders
• Problems Associated with Childhood Disorders
• Treatment of Childhood Disorders

Module Learning Outcomes

• Describe the signs and symptoms of Childhood Disorders
• Identify the common nursing problems associated with Childhood Disorders
• Summarize the treatment of Childhood Disorders

Concepts

• Development
• Coping
• Safety

Overview

In this module, we will cover matters related to childhood disorders to include their clinical presentation, assessment, and treatment options. Our discussion will include Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), and Intellectual Disability (ID). Duckworth (2022) reported half of mental health disorders begin by the age of 14 years and three quarters by the age of 25 years. Children may experience similar mental health diagnoses as adults. However, assessment and diagnosis of a mental health issue in childhood presents with challenges.

Videbeck (2020) lists several reasons psychiatric disorders are not easily diagnosed in children compared to adults; these reasons are:

• May lack abstract cognitive and language skills to describe their symptomology
• Have a limited sense of stable and normal sense of self related to constant developmental changes; thus, may not be able to discriminate unusual versus typical/expected feelings/sensations
• Abnormal or problematic behaviors may vary dependent on developmental stage and/or age

ADHD

ADHD is characterized by cognitive and functional deficits. Clinically, this typically presents as issues with

• inattention
  ADHD Diagnosis: look for consistency in signs and symptoms in multiple settings with various caregivers.
• hyperactivity
• and impulsiveness (Magnus et al., 2022; Videbeck, 2020).

Historically, ADHD has been misdiagnosed. Alternative explanations for abnormal child behavior may be related to another mental health diagnosis (i.e., not ADHD, but another diagnosis) or stressful family situations (e.g., divorce) (Videbeck, 2020). The key is to look for consistency in signs and symptoms in multiple settings with various caregivers (Magnus et al., 2022; Videbeck, 2020). In puberty, ADHD may result in behaviors such as skipping class, interpersonal relationship difficulties, and risk-taking (Videbeck, 2020).  Lastly, it is a myth that children will outgrow ADHD. Instead, untreated, ADHD can result in adulthood dysfunction (e.g., work performance) (Magnus et al., 2022).

ASD

ASD presents with repetitive schemes affecting behaviors, interests, or activities which may be present in early childhood or, alternatively, the child may begin with typical development, but then may have a regression of skills (Mughal et al., 2022).  Diagnostically, Rhoads (2021) provides an overview of the DSM-5 signs and symptoms of ASD affect the three areas of abnormal or impairment in social interactions, communication impairment, and restricted repetitive or stereotyped behavior patterns. Keep in mind, at this time, there is no cure, nor is there any specific medication for ASD; rather, certain psychotropic medications may be used to treat underlying behaviors (e.g., Risperidone and Aripiprazole) (Rebar et al., 2020). Early identification and treatment of ASD may improve outcomes (Mughal et al., 2022).

Videbeck (2020) provide typical behaviors observed in ASD; these are:

• Avoids eye contact
• A preference to be alone
• Delay in speech and language
• Obsessive interests
• Word/phrase repetition
• Lack of interest or pretend play
• Distressed by minor changes in routine
• Hand-flapping, body rocking or spinning
• Uncommon reactions to sensory experiences

Level Up RN. (2022). ADHD and autism-pediatric nursing-nervous system disorders [Video]. YouTube. https://youtube.com/watch?v=PzFpNWZwl3Q&si=EnSIkaIECMiOmarE

ID

An individual diagnosed with an ID has limitations in intellectual function and adaptive behavior beginning at birth (Lee et al., 2022). A deficit in intellectual functioning may impact one’s ability to logically reason or solve problems, learn, verbal skills (Lee et al., 2022). Deficits in adaptive behavior are related to social/interpersonal, conceptual (e.g., time), and practical skills (e.g., activities of daily living) (Lee et al., 2022). An intelligence quotient (IQ) of 70 or below with adaptive function impairment is suggestive of an ID (Lee et al., 2022).

Psych Hub. (2022). What is IDD? [Video]. YouTube. https://youtube.com/watch?v=rymHXQmiugI&si=EnSIkaIECMiOmarE

• Risk for Injury
• Impaired Social Interaction
• Impaired Verbal Communication

Treatment

There are four general treatment considerations for childhood disorders.

1. First and foremost, always ensure the child’s safety.
2. Early identification and treatment are key to promote a child’s mental health.
3. Focus on strengths, not just problems.
4. Provide parental support and make referrals as needed.

ADHD

Those diagnosed with ADHD need help to manage inattentiveness, hyperactivity, and impulsivity. As mentioned in the previous paragraph, safety is priority. Children diagnosed ADHD may act without thinking of their safety. In the acute care setting, stimulant medications are first-line treatment options (e.g., Methylphenidate/Ritalin) and non-stimulants tend to be the 2nd line of treatment (e.g., Atomoxetine/Strattera) (Rhoads, 2020). See the MODULE 4: PSYCHOPHARMACOLOGY for a review of these medications.

Consider using behavior modification and reward for desired behavior (Rhoads, 2020). Some interventions specific to chronic care include:

• Limit distractions, when completing homework
• Help the child organize their environment
• Keep tasks simple and use simple instructions (Rhoads, 2020).

ASD

In general, for the best treatment outcomes a highly structured and specialized treatment plan works best (Mughal et al., 2022; Rhoads, 2020). Rhoads (2020) indicates a multi-faceted treatment program might entail:

• Behavioral and communication approaches (e.g., positive reinforcement and social skills training)
• Biomedical and dietary approaches (e.g., medications used to treat problem behaviors or underlying conditions)
• Community support and parent training (e.g., teach family about ASD and management strategies)
• Specialized therapies (e.g., speech, occupational, and physical therapy)
• Complementary approaches (e.g., music, play, art, and animal therapy)

ID

Individuals diagnosed with an ID benefit from an interprofessional approach (e.g., physician, psychiatrist, neurologist, speech pathologist, special nurse educator, social worker, and pharmacist) and multimodal interventions such as educational support, behavioral intervention (e.g., CBT, vocational training, family education, governmental resources), and psychotropic medications (if there is a co-existing condition such as aggressive behavior) (Lee et al., 2022).

Summary of Key Nursing Interventions for ADHD, ASD, and ID

(Summarized from Magnus et al., 2022; Mughal et al., 2022; Rebar et al., 2020; Rhoads, 2021; Videbeck, 2020).

Additional Resources

• Check out the resources listed on the Society for Adolescent Health and Medicine website.