CHILDHOOD

DISORDERS

Pervasive Developmental Disorder

Disintegrative Disorder
Attention Deficit and Disruptive Behavior
Disorders
Tic Disorders
Elimination Disorders

Autistic Disorder
Asperger Syndrome
Rett Syndrome
Childhood Disintegrative Disorder

PERVASIVE DEVELOPMENTAL
DISORDERS

Autistic Disorder
Impairment in communication skills
Stereotype behavior, interest and
activities
Impairment in social interaction
Provide structured environment
(routines)
Priority nursing diagnosis: Risk for
Injury

Aspergers Syndrome
Impairment social interaction & nonverbal communication
Restricted & repetitive patterns of
behavior
Intact linguistic and cognitive
development
May stick to inflexible routines

Rett Syndrome
Common among female; rare among
males
Development of multiple deficits
after a period of normal functioning
May develop between birth to 5
months of age

Childhood Disintegrative Disorder

Regression in skills after an average
of 3 YEARS of normal development

Attention Deficit Hyperactivity Disorder (ADHD)

Attention Deficit Disorder (ADD)
Oppositional Defiant Disorder
Conduct Disorder

ATTENTION-DEFICIT & DISRUPTIVE

BEHAVIOR DISORDERS

Attention Deficit Hyperactivity

Disorder (ADHD)
It is disorder characterized by persistent pattern of
attention, hyperactive and impulsive behavior.
Occurs below the age of 7
More common in boys
The main problem are the inattentiveness and
hyperactivity
Factors that may lead to are neurological impairment,
prenatal trauma, early malnutrition, frontal lobe hypo
perfusion and mothers use of drugs during pregnancy
Priority diagnosis is the risk for injury
Priority needs are nutrition and safety

Attention Deficit Hyperactivity

Disorder (ADHD)
INATTENTIVE
BEHAVIOR

Misses details
Makes careless mistakes
Has difficulty sustaining attention
Doesnt seem to listen
Does not follow-through on chores
or homework
Has difficulty with organization
Avoids tasks requiring mental effort
Often loses necessary things
Is easily distracted by other stimuli
Is often forgetful in daily activities

HYPERACTIVE/IMPUSIVE
BEHAVIOR

Fidgets
Often leaves seat, (e.g.,
during a meal)
Runs or climbs excessively
Cant play quietly
Is always on the go; driven
Talks excessively
Blurts out answers
Interrupts
Cant wait for turn
Is intrusive with
siblings/playmates

Attention Deficit Hyperactivity

Disorder (ADHD)
3 subtypes of ADHD
Predominantly Inattentive Presentation: This is
what is typically referred to when someone uses the
term ADD. This means a person shows enough
symptoms of inattention, but doesnt meet the full
criteria for hyperactivity and impulsivity.
Predominantly Hyperactive-Impulsive
Presentation: Inversely, this type occurs when a
person has enough symptoms of hyperactivity and
impulsivity but not enough for inattention.
Combined Presentation: This type is when a person
meets the criteria of both inattention and hyperactivity
and impulsivity.

Attention Deficit Hyperactivity

Disorder (ADHD)
Psychopharmacologic Management
Ritalin
Adderall
Strattera
Psychiatric Interventions
Therapeutic Play

Conduct Disorder
a psychological disorder diagnosed in childhood or
adolescence that presents itself through a
repetitive and persistent pattern of behavior in
which the basic rights of others or major ageappropriate norms are violated.
often seen as the precursor to antisocial personality
disorder, which is not diagnosed until the individual
is 18 years old
there are four categories that could be present in
the child's behavior: aggression to people and
animals, destruction of property, deceitfulness or
theft, and serious violation of rules

Conduct Disorder
Management
Decreasing violence and increasing
compliance with treatment
Improving coping skills and selfesteem
Promote social interaction
Provide client & family education

Oppositional Defiant Disorder

a pattern of angry/irritable behavior, or
vindictiveness lasting at least 6 months, and is
exhibited during interaction with at least one
individual that is not a sibling.
Individuals must display four symptoms from one of
the following categories: angry/irritable mood,
argumentative/defiant behavior, or vindictiveness.
children with oppositional defiant disorder are not
aggressive towards people or animals (even though
this directly contradicts the "signs and symptoms"),
do not destroy property, and do not show a pattern
of theft or deceit.

Oppositional Defiant Disorder

DSM Criteria
At least 4 of the following, for at least 6 months:
Actively refuses to comply with majority's requests or
consensus-supported rules.
Performs actions deliberately to annoy others.
Angry and resentful of others
Argues often.
Blames others for his or her own mistakes.
Frequently loses temper.
Spiteful or seeks revenge.
Touchy or easily annoyed

Pica
Rumination Disorder
Feeding Disorder

FEEDING & EATING

DISORDERS

Pica
is persistent ingestion of nonnutritive
substances such as paint, hair, cloth,
leaves, sand, clay, or soil.
Behavior may last for several months
and then remits

Rumination Disorder
is the repeated regurgitation and
rechewing of food.
regurgitation does not involve
nausea, vomiting, or any medical
condition

Feeding Disorder
characterized by persistent failure to
eat adequately, which results in
significant weight loss or failure to
gain weight.

Tourettes Disorder
Vocal Tics
Motor Tics

TIC DISORDER
A tic is a sudden, rapid, recurrent, nonrhythmic,
stereotyped motor movement or vocalization

Tourettes Disorder
usually first diagnosed in infancy,
childhood, or adolescence" according
to type (motor or phonic tics) and
duration (transient or chronic
diagnosed when multiple motor tics,
and at least one phonic tic, are
present for more than a year

Enuresis
Encopresis

ELIMINATION DISORDER

Enuresis
is the repeated voiding of urine
during the day or at night into
clothing or bed by a child at least 5
years of age either chronologically or
developmentally.
DOC: imipramine (Tofranil)

Encopresis
is the repeated passage of feces into
inappropriate places, such as
clothing or the floor, by a child who is
at least 4 years of age either
chronologically or developmentally.

Other Childhood disorders

Separation Anxiety
Reactive Attachment Disorder
Selective Mutism
Stereotypic Movement Disorder

SLEEP DISORDER
Dysomnias
Parasomnias

DYSOMNIA
Characterized by disturbances in the
amount, quality, or timing of sleep
Insomnia
Hypersomnia
Narcolepsy

Insomnia
Difficulty in initiating or maintaining
sleep.
Should last for 1 month or more with
significant impairment in functioning
Management
Stimulus control
Sleep restriction
Relaxation therapy

Hypersomnia
Extreme daytime sleepiness
No REM sleep is noted during
daytime sleep
Nighttime sleep remains normal

Narcolepsy
Hypersomnia
(increase in the amount of REM sleep)
+
Hypnogogic Hallucination
(may be accompanied by sleep
paralysis)
+
Cataplexy

PARASOMNIA
Profoundly disturbed sleep accompanied
by physiologic and behavioral reactions.
Nightmares
Sleep Terrors
Sleep Walking (Somnambulism)
Bruxism
Sleep Talking
Sleep Paralysis

Abuse & Violence

The wrongful use and
maltreatment of another
person

VIOLENCE
Components:
Physical force
Unjust strength
Power
Consequence for perpetrators and victims
Arouses fear in others
Threat to personal safety
Trauma remains vivid in dreams and thoughts
May be premeditated or spontaneous
Intense hatred and rage

ANGER
Characteristic findings of anger
Muscle rigidity
Flushed face
Pacing
Pounding
Stomping
Loud voice
Speeded up body movements
Glaring

FAMILY VIOLENCE
Characteristics of Violent Families
Social isolation
Abuse of power and control
Alcohol and other drug abuse
Intergenerational transmission process

FAMILY VIOLENCE
Characteristics of the VICTIMIZER (Perpetrator)
1. Impaired self-esteem
2. Strong, unrealistic dependency needs
3. Immaturity
4. Self-absorption
5. Narcissistic
6. Suspicious
7. History of sexual abuse during childhood
8. Perceive victims as property
9. Believe they are entitled to abuse victim

FAMILY VIOLENCE
Characteristics of the Victim
1. Feels like a captive in the system
2. Dependent
3. Helpless
4. Powerless
5. Blame themselves
6. Low self-esteem
7. Depressed

CHILD ABUSE OR NEGLECT

Physical or mental injury

Sexual abuse
Negligence
Maltreatment
Under 18 years of age
Usually is the person responsible for childs welfare
Mandatory reporting is required by nurses for
confirmed or suspected cases
Vulnerable population because of victims dependence
on care provider
Cyclical, repetitive acts of abuse are typical

SUBJECTIVE CUES

Night terrors
Chronic Fatigue
Sleep talking
Enuresis
Insomnia
Increased sleeping
Weight loss/weight gain

OBJECTIVE CUES

External signs of trauma

Scarring of different
stages
Head injuries
lack of immunization
and dental care
Fear in the presence of
parents or care provider

CHILD ABUSE OR NEGLECT

ELDER ABUSE & NEGLECT

Causes
Alcohol abuse
Unemployment
Change in living arrangement, such as when
a son and family move into mothers home
Burden of caring for ill older parent
Isolation
Rigid, compulsive, inflexible
History of abusive relationship

ELDER ABUSE & NEGLECT

Types of abuse
Physical infliction of pain or injury
Sexual
Psychological infliction of mental
anguish by demeaning, name calling,
insulting
Financial/materials Exploitation using
assets, funds for personal gain.

ELDER ABUSE & NEGLECT

Types of neglect
Passive

Unintentional failure to caretaking of elder

persons physical, emotional or financial
needs.

Active

Abandonment, denial of food, shelter,

clothing, medical assistance, personal
needs, isolation; an intentional neglect.

PHYSICAL ABUSE

Fractures
Welts
Lacerations
Punctures
Burns
Bruises
Shape similar to an object (belt marks, fingers)
Bilateral on upper arms
Clustered on trunk

SEXUAL ABUSE

Torn ,stained, or bloody underclothing

Difficulty in walking or sitting
Pain, itching, bruising, or bleeding in
genital area
Unexplained venereal disease or
genital infections

PSYCHOLOGICAL ABUSE

Confusion
Excessive fear
Sleep disorders
Change in appetite
Unusual weight gain or loss
Loss of interest in self, activities, or environment
Ambivalence
Withdrawal
Agitation

FINANCIAL ABUSE

Inaccurate, confused, or no knowledge

of finances
Unexplained inability to pay bills
Disparity between income/assets and
lifestyle
Fear when discussing finances

NEGLECT

Dehydration
Malnutrition
Hypo/hyperthermia
Excessive dirt or odor
Inadequate or inappropriate clothing
Absence of eyeglasses, hearing aids,
dentures
Sign of excess drugging
Decubitus ulcers

SPOUSE ABUSE

Often age 18 or older

Involves a relationship with spouse or a partner
Commonly an international act of physical
violence
No uniform laws mandating reporting
Often happens first during a pregnancy
Abused spouse/partner reluctant to reveal cause
of injuries
Abused spouse/partner often blamed for not
leaving

SPOUSE ABUSE
Common injuries from abuse
Facial injuries
Head injuries
Fractures of upper extremities
Joint tenderness
Strangulation marks on neck
Cigarette burns
Spontaneous abortion
Human bite marks
Trauma to genitalia

Tension-building phase

Minor assaults
Verbal Assault
Threats
Victim attempts to comply
Alienation from support
systems

CYCLE OF VIOLENCE
Honeymoon period

Explosion

Tenderness
Love
Truce

Major trauma
Destructiveness
Lack of control
Victims protect themselves
Victims underplay the
severity

RAPE

engaging another person in sexual intercourse

through the use of force and without the
consent of the sexual partner

Statutory rape The act of sexual

intercourse with a person under the age of
legal consent. NOTE: sexual intercourse with a
minor is rape, even with consent of the minor.
Acquaintance rapes involves someone
known to the victim

RAPE
Categories of rapists:
Sexual sadists who are aroused by the pain of
their victims
Exploitive predators who impulsively use their
victims as objects for gratification
Inadequate men who believe that no woman
would voluntarily have sexual relations with
them and are obsessed with fantasies about sex
Men for whom rape is a displaced expression of
anger and rage

RAPE ASSESSMENT DATA

Last menstrual period

Form of birth control used by client
Determine last act of coitus before rape
Penile penetration
Orifices violated
Duration of intercourse
Use of condom by perpetration
Has client bathed, showered, douched, urinated, defecated,
vomited, cleansed mouth?
Pelvic exam
Swabs taken of body cavities for semen
Oropharyngeal trauma due to oral penetration
Gastrointestinal disturbances

RAPE ASSESSMENT DATA

Fear
Loss of control
Guilt for having survive
Shame
Embarrassment
Humiliation
Obssessive thoughts What could have done differently
Anger
Revenge
Change in residence
Changes in relationships with men
Hesitation to tell others for fear of not being believed

RAPE
Nursing Interventions
Encourage not to shower, bathe, douche, or
change clothing
Preserve all evidence
Treat physical injuries
Reassure of safety
Help victim refrain from self blame
Refer to crisis intervention, legal aid
Refer to support group

LOSS & GRIEF

5 Categories of loss
1.
2.
3.
4.
5.

Loss
Loss
Loss
Loss
Loss

of
of
of
of
of

external object
known environment
significant others
aspect of self
life

Grief

is form of sorrow involving thoughts,

feelings and behaviors
Engle (1964)
Kubler-Ross (1969)
Process Oriented
Behavior oriented
Shock and disbelief Denial
Developing
Anger
Awareness
Bargaining
Reorganization and Depression
Restitution
Acceptance

Infant and Toddler

Live only at present

Are concern with separation with
mother, afraid of being alone/being
abandoned
Can sense sadness from others and
may feel guilty due to magical
thinking
Healthy toddlers may insist on seeing
other long after the persons death

Pre-school

See death as temporary type of

separation as if it is a sleep
separation
See life as concrete, know the word
death but doesnt know its finality
Fear of separation from parents
wanted to know who will take care of
them
Dying children may have regress
behavior

School Age

Have concept of time, causality and

irreversibility of death
They fear of mutilation, pain
abandonment
Interested with death ceremony
Feel/Interpret death as a punishment

Cultural and spiritual belief

Values, attitudes, belief and customs

are cultural aspect of a persons life
style
Spiritual or religious belief includes
practices, rites and rituals directed
toward loss experience and grieving