TABLE 6-10 Emotional Disturbances in Children

Stage Disturbance Assessment: Symptoms or Characteristics/th> Analysis: Behavior Related To: Plan/Implementation:

Latency (6-12 years)
Attention deficit disorder (hyperactivity and hyperkinesis)
Both hyperactivity and hyperkinesis are occasionally observed in schoolchildren; characterized by a short attention span, restlessness, distractibility, and impulsivity.
  1. An organic disturbance of the CNS, of uncertain origin, as the basis of hyperkinesis. Because the primary symptom-difficulty with attention span-is the same as that presented by the hyperactive child, the hyperactive child is frequently and incorrectly labeled hyperkinetic.
  2. Attempts by hyperactive child to control anxiety through reducement (and can attend when interested or relaxed). Does not fit smoothly into environment, but problem may be with the environment rather than the child. In other words, the school situation requires a high degree of conformity. The child who does not fit the mold is not necessarily emotionally disturbed.
  • For the hyperkinetic child, psychopharmaceutical intervention-usually Ritalin-is most often employed. Psychotherapy and special education classes may also be indicated. Ritalin is also frequently prescribed for the hyperactive child-which raises the issue of whether an individual should be medicated to fit more smoothly into the environment.
  • Therapy can help the hyperactive child decrease anxiety and increase selfesteem, thus reducing the symptoms.

Withdrawal
Reduced body movement and verbalization, lack of close relationships, detachment, timidity, and seclusiveness.
Need to withdraw as a defensive behavior, through which the child controls anxiety by reducing contact with the outer world. Like
Offer positive reinforcement when child is more active. Help child assert self and experience success at certain tasks.

  • the overcomplaint child, the withdrawn child is frequently not identified as needing help because this behavior is not a “problem."
  • The nurse needs to work with parents who are overprotective.
  • Therapy may be useful to work through anxiety and provide child with a chance to form a trusting relationship with another.

Psychophysiological symptoms
The child experiences physical symptoms (such as vomiting, headaches, eczema, asthma, colitis) with no apparent physiologic cause.
  • Conversion of anxiety into physical symptoms.
  • After medical evaluation has established lack of physiological etiology, psychotherapy is usually indicated.
  • Family therapy may be treatment of choice because dysfunctional interpersonal family dynamics are common in these cases.
  • The nurse can also provide the child with a healthy interpersonal relationship. Nurses are frequently in a position to talk to parents and teachers about the importance of mental health counseling for children with physical symptoms.

Separation anxiety disorders (school “phobia”)
Sudden and seemingly inexplicable fear of going to school. These children often do not know what it is they fear at school. Frequently occurs after an illness and absence from school or birth of sibling.
  • An acute anxiety reaction related to separation from home (not actually a phobia).
  • If the child is allowed to stay home, the dread of returning to school usually increases.
  • The child and parent should have psychiatric intervention quickly (before the problem becomes worse) to help the child separate from the parent.

Learning disabilities
Failure or difficulty in learning at school.
  1. Emotional disorders, which cause school failure.
  2. Feelings of inferiority, discouragement, and loss of confidence from school failure. Learning disabilities may be caused by many factors or combinations of factors, including anxiety, poor sensory or sensorimotor integration, dyslexia, receptive aphasia.
  • A comprehensive evaluation is essential. Ideally, this would include assessments by a pediatric neurologist, a mental health worker such as a psychiatric nurse or psychiatrist, a learning disabilities teacher specialist, and possibly an occupational therapist trained to work with sensory integration. Treatment is then based on the specific problem or problems.

Conduct disorders
Behavior that is nonproductive; that is repeated in spite of threats, punishments, or rational argument; and that usually leads to punishment. Persistent stealing and truancy are examples.
  • Conflicts that are expressed and communicated through behavior rather than verbally. Child knows what he or she is doing but is unaware of the underlying motivations for the problem behavior.
  • Counseling or therapy for the child by a child psychiatric nurse or other mental health worker can allow the child to resolve the basic conflict, thus making the problem behavior unnecessary.