Mental Illness in Children and Adolescents

Question 1

What are protective factors within children that can protect them from mental illness?

Answer 1

-“normal” physical and psychosocial development
-an “easy” temperament
-secure attachment
-learning ability
-sense of competence
-positive beliefs
-lone-term support from at least 1 adult

Question 2

What are some protective factors within a family that protect them from mental illness?

Answer 2

-low stress
-stable employment
-adequate resources for child care
-higher SES

Question 3

What are some protective factors that can help protect a child against mental illness?

Answer 3

-positive and cohesive families, schools and neighbourhoods

Question 4

Describe an easy temperament

Answer 4

positive mood, regular patterns, positive approaches, low emotional intensity

Question 5

Describe a difficult temperament

Answer 5

irregular patterns, negative responses to new stimuli, slow adaptation, negative mood, and high emotional intensity

Question 6

Describe a slow-to-warm temperament

Answer 6

negative, mildly emotional response to new situations, but adaptation evolves

Question 7

What are some common childhood stressors?

Answer 7

loss: death and grieving
separation and divorce
stressful sibling relationships
physical illness
adolescent risk-taking behaviours

Question 8

What are some examples of risk-taking behaviours in adolescents?

Answer 8

smoking, alcohol, unprotected sex, truancy, delinquent behaviours and running away

Question 9

What are some interventions for adolescent risk-taking behaviours?

Answer 9

-intervene at peer level, educational programs
-alternative recreation activities
-peer counseling

Question 10

What makes up a developmental assessment?

Answer 10

-intellectual functioning
-language
-gross and fine motor functioning
-cognition

Question 11

What should you do to build rapport during an interview with a child and their parents?

Answer 11

-maintain appropriate eye contact, speak slowly, clearly and calmly with friendliness and acceptance
-use a warm, expressive tone
-show interest in what is being said
-make the interview a joint undertaking

Question 12

What are the difficulties with interviewing preschool children?

Answer 12

They have difficulty putting feelings into words, thinking concrete
-use play; conduct assessment in play room

Question 13

What are the aspect of interviewing school-age children?

Answer 13

Able to use constructs, provide longer explanations
-establish rapport through competitive games

Question 14

What are the unique aspects of interviewing adolescents?

Answer 14

Can seem egocentric, increased self-consciousness, fear of being shamed
-let them know what information will be shared with parents
-direct, candid approach

Question 15

What are neurodevelopmental disorders?

Answer 15

-significant delay in one or more lines of development
-developmental pathways and developmental delays are closely interwoven
-disorders usually first diagnosed in infancy, childhood or adolescence

Question 16

What are the signs of neurodevelopmental disorders?

Answer 16

-may or may not have an intellectual disability
-uneven pattern of intellectual strengths and weaknesses
-developmental delay (developmental outside the norm)

Question 17

What are some types of developmental delays?

Answer 17

-socialization
-communication
-peculiar mannerisms
-idiosyncratic interests

Question 18

What are some learning disorders?

Answer 18

verbal: dyslexia (reading) and dysgraphia (written expression)

nonverbal: dyscalculia (math)

Question 19

What are some examples of motor disorders?

Answer 19

Stereotypic movement disorder (body ricking, head nodding, hand shaking, waving)
Self-injurious behaviours
Tourette’s disorder

Question 20

Define tics

Answer 20

sudden, rapid, repetitive, stereotyped motor movements or vocalizations
-have to have the tics for at least 1 year to be diagnosed

Question 21

What are the characteristics of autism spectrum disorder?

Answer 21

-deficits in social communication and social interaction
-restricted repetitive behaviours, interests, and activities (RRBs)

Question 22

What are the clinical symptoms of autism spectrum disorder?

Answer 22

-delayed and deviant language, or concrete thinking
-pronoun reversals and abnormal intonation
-stereotypical behaviour: repetitive rocking, insistence on sameness, self-injurious behaviour

Question 23

When is the onset of autism spectrum disorder?

Answer 23

onset is early, usually before 30 months

Question 24

What is the cause of autism?

Answer 24

exact cause is unknown but is likely a combination of genetics, perinatal insult and impaired parent-child interactions, increased platelet serotonin, excessive dopaminergic activity, and alteration in opioids

Question 25

What are some pharmacological interventions for autism?

Answer 25

Antipsychotics Methylphenidate (Ritalin) Opioid antagonist SSRIs Lithium Beta-blockers Buspirone and trazodone

Question 26

What are some non-pharmacological interventions for autism?

Answer 26

ABA: applied behaviour analysis ABM: anat baniel method

Question 27

What is Applied Behaviour Analysis (ABA)?

Answer 27

a process of systemically applying interventions, based on the principles of learning theory, to improve socially significant behaviours (the goal is to determine what happens to trigger a behaviour, and what happens after that behaviour to reinforce it)

Question 28

What is Anat Baniel Method (ABM)?

Answer 28

NeuroMovement: accessing the power of the brain to change itself by creating new neural patterns

Question 29

What is Asperger's Disorder?

Answer 29

-severe and sustained impairment in social interaction and restricted, repetitive patterns -profound social deficits

Question 30

What are the profound social deficits seen in Asperger's Disorder?

Answer 30

-inappropriate initiation of social interactions -inability to respond to social cues -concrete in interpretation of language -stereotypical behaviour

Question 31

What are the nursing interventions for Asperger's Disorder?

Answer 31

-promoting interaction -ensuring predictability and safety -managing behaviour -supporting the family

Question 32

What are the disruptive behaviour disorders?

Answer 32

Attention Deficit/Hyperactivity Disorder Oppositional Defiant Disorder Conduct Disorder

Question 33

What is the pharmacologic treatment for ADHD?

Answer 33

Stimulants: they increase ability to concentrate, improve focus and increase motivation -they increase dopamine and norepinephrine Non-stimulants: SNRI, adrenergic receptor agonists (Guanfacine and Catapres), Bupropion, Modafinil -less effective but fewer side effects and minimal abuse potential

Question 34

What are the stimulants used for treatment of ADHD?

Answer 34

Methylphenidates (Biphentin, Concerta, Ritalin): acts faster but doesn't last as long (lasts 4 hours) Amphetamines (Adderall): longer onset but lasts longer

Question 35

What are the side effects of stimulants used for treatment of ADHD?

Answer 35

growth restriction, appetite suppression, irritability, agitation, restlessness, insomnia, abuse potential

Question 36

What are the nursing management strategies/interventions for ADHD?

Answer 36

-Cognitive behavioural techniques -set clear limits with clear consequences -establish/maintain predictable environment with decreased stimuli -establish eye contact before giving directions; as to repeat what was heard -encourage child to do homework -encourage 1 assignment at a time -improving self-esteem

Question 37

Describe Oppositional Defiant Disorder

Answer 37

-angry and irritable mood -disobedient, argumentative -defiant and vindictive behaviour -they experience social difficulties (trouble making friends), conflicts with authorities -academic problems

Question 38

Describe Intermittent Explosive Disorder

Answer 38

-inability to control aggressive impulses -usually begins in late childhood/adolescence, the extends into adulthood -leads to problems with interpersonal relationships, occupational difficulties, and criminal difficulties

Question 39

Describe Conduct Disorder

Answer 39

-behaviour is usually abnormally aggressive -rights of others are violated and societal norms or rules are disregarded -complications such as academic failure, school suspensions and dropouts, juvenile delinquency, drug and alcohol abuse, and juvenile court involvement Two problems: pyromania and kleptomania

Question 40

Which adolescent disorder is more likely to lead to criminality and a later diagnosis of antisocial personality disorder?

Answer 40

Conduct disorder

Question 41

Describe Separation Anxiety Disorder

Answer 41

-related to school phobia -4% of school-age children -runs in families -may emerge after a change -may require medication-- antidepressants -treatment can be psychotherapy or behaviour therapy

Question 42

Describe Obsessive-Compulsive Disorder in adolescents

Answer 42

-may have onset in childhood -exposure and response prevention Obsessions: unwanted persistent, intrusive thoughts, impulses or images related to anxiety Compulsions: unwanted behavioural acts or patterns of behaviour

Question 43

Which mood disorder is extremely rare in children?

Answer 43

Bipolar disorder