Children have certain developmental tasks to master in the various stages of development (e.g., 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. Table 10-10. Emotional Disturbances in Children summarizes key age-related disturbances, lists main symptoms and analyses of causes, and highlights medical interventions and nursing plan/implementation.
5. Children are not miniature adults; they have special needs.
6. 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.
7. Children who are physically or emotionally ill regress, giving up previously useful habits.
8. Adolescents have special problems relating to need for control versus need to rebel, dependency versus interdependency, and search for identity and self-realization.
9. Adolescents often act out their underlying feelings of insecurity, rejection, deprivation, and low self-esteem.
10. 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 spectrum disorders(previously called childhood schizophrenia; most common form of pervasive developmental disorders [PDDs])—assessment (before age 3):
1. Disturbance in how perceptual information is processed (sensory integrative dysfunction); normal abilities present.
1. Behave as though they cannot hear, see, etc.
2. Do not react to external stimulus.
3. Sensory defensiveness:
1. Might dislike specific food textures or temperatures.
2. Covers ears in response to loud noises.
3. Can't concentrate if there are competing noises in environment.
4. Might dislike riding or climbing on play equipment.
5. Doesn't like people standing too close or being touched.
6. Stimuli might be interpreted as threatening or anxiety provoking.
7. Responds in an exaggerated manner (cries, is negative, resistant, or rigid) when a situation makes it difficult for child to process.
4. Low muscle tone results in inability to maintain stable positions or postures (e.g., standing on one leg); avoids gross and fine motor movement.
2. Lack of self-awareness as a unified whole—may not relate bodily needs or parts as extension of themselves.
3. Severe difficulty in social interaction and communicating with others—may be mute or echolalic and isolated.
4. Bizarre restricted and repetitive postures and gestures (banging head, rocking back and forth), and routines.
5. Disturbances in learning: difficulties in understanding and using language.
6. Etiology is unknown; but generally accepted that irregularities in brain structure or function may be congenital or acquired.
7. Prognosis depends on severity of symptoms and age of onset (can exhibit any combination of symptoms and behaviors).
2. Other pervasive developmental disorders include: Asperger's disorder(speak at normal pace and have normal intelligence, but have stunted social skills, limited and obsessive interests), childhood disintegration disorder (CDD), and Rett's disorder. 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, fire setting, and criminal gang activity; 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.