Mental and Emotional Disorders in Children and Adolescents

Children have certain developmental tasks to master in the various stages of development (learning to trust, control primary instincts, and resolve basic social roles).

1. Concepts and principles related to mental and emotional disorders in children and adolescents:
   1. Most emotional disorders of children are related to family dynamics and the place the child occupies in the family group.
   2. Children must be understood and treated within the context of their families.
   3. Many disorders are related to the phases of development through which the children are passing. (Erik Erikson’s developmental tasks for children are trust, autonomy, initiative, industry, identity, and intimacy.)
   4. Children are not miniature adults; they have special needs.
   5. Play and food are important media to make contact with children and help them release emotions in socially acceptable forms, prepare them for traumatic events, and develop skills.
   6. Children who are physically or emotionally ill regress, giving up previously useful habits.
   7. Adolescents often act out their underlying feelings of insecurity, rejection, deprivation, and low self-esteem.
   8. Strong feelings may be evoked in nurses working with children; these feelings should be expressed, and each nurse should be supported by team members.


2. Assessment of selected disorders:
   1. Autistic disorders (previously called childhood schizophrenia):
      1. Disturbance in how perceptual information is processed; normal abilities present.
         1. Behave as though they cannot hear, see.
         2. Do not react to external stimulus.
         3. Mute or echolalic.
      2. Lack of self-awareness as a unified whole- may not relate bodily needs or parts as extension of themselves.
      3. Severe difficulty in communicating with others-may be mute and isolated.
      4. Bizarre postures and gestures (banging head, rocking back and forth).
      5. Disturbances in learning.
      6. Etiology is unknown.
      7. Prognosis depends on severity of symptoms and age of onset.
   2. Developmental disorders (brain injury) characteristics:
      1. Hyperactivity.
      2. Explosive outbursts.
      3. Distractibility.
      4. Impulsiveness.
      5. Perceptual difficulties (visual distortions, such as figure-ground distortion and mirror reading; body-image problems; difficulty in telling left from right).
      6. Receptive or expressive language problems.
   3. Elimination disorders (functional enuresis)-related to feelings of insecurity due to unmet needs of attention and affection; important to preserve their self-esteem.
   4. Separation anxiety disorders of childhood (school phobias)-anxiety about school is accompanied by physical distress. Usually observed with fear of leaving home, rejection by mother, fear of loss of mother, or history of separation from mother in early years.
   5. Conduct disorders-include lying, stealing, running away, truancy, substance abuse, sexual delinquency, vandalism, and fire setting; chief motivating force is either overt or covert hostility; history of disturbed parent-child relations.


3. Analysis/nursing diagnosis:
   1. Altered feeling states: anxiety, fear, hostility related to personal vulnerability and poorly developed or inappropriate use of defense mechanisms.
   2. Risk for self-mutilation related to disturbance in self-concept, abnormal response to sensory input, and history of abuse.
   3. Altered interpersonal processes:
      1. Impaired verbal communication related to cerebral deficits, withdrawal into self, inability to trust other.
      2. Altered conduct/impulse processes: aggressive, violent behaviors toward self, others, environment related to feelings of distrust and altered judgment.
      3. Dysfunctional behaviors: age-inappropriate behaviors, bizarre behaviors; disorganized and unpredictable behaviors related to inability to discharge emotions verbally.
      4. Impaired social interaction: social isolation/ withdrawal related to feelings of suspicion and mistrust, lack of bonding, inadequate sensory stimulation.
   4. Personal identity disturbance related to lack of development of trust, organic brain dysfunction, maternal deprivation.
   5. Altered parenting related to ambivalent or dissonant family relationships and failure of child to meet role expectations.
   6. Sensory/perceptual alterations: altered attention related to disturbed mental activities.
   7. Altered cognition process: altered decision making, judgment, knowledge, and learning processes; altered thought content and processes related to perceptual or cognitive impairment and emotional dysfunctioning.


4. Nursing care plan/implementation in mental and emotional disorders in children and adolescents:
   1. General goals: corrective behavior-behavior modification.
   2. Help children gain self-awareness.
   3. Provide structured environment to orient children to reality.
   4. Impose limits on destructive behavior toward themselves or others without rejecting the children.
      1. Prevent destructive behavior.
      2. Stop destructive behavior.
      3. Redirect nongrowth behavior into constructive channels.
   5. Be consistent.
   6. Meet developmental and dependency needs.
   7. Recognize and encourage each child’s strengths, growth behavior, and reverse regression.
   8. Help these children reach the next step in social growth and development scale.
   9. Use play and projective media to aid working out feelings and conflicts and in making contact.
   10. Offer support to parents and strengthen the parent-child relationship.
   11. Health teaching: teach parents methods of behavior modification.


5. Evaluation/outcome criteria:
   1. Destructive behavior is inhibited.
   2. Demonstrates age-appropriate behavior on developmental scale.