Jiraporn Rakkarn, MNS, RN Division of Mental Health and Psychiatric Nursing
College of Nursing and Health, Suan Sunandha Rajabhat University
Nursing Care for Child with
Psychiatric Disorders
Mental Retardation/ Intellectual Disability
Autistic Disorders
Attention Deficit Hyperactivity Disorders: ADHD
Conduct Disorders: CD
Contents
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
Content
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
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Mental Retardation (Intellectual Disability)
Definition
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
DSM-IV Mental retardation
DSM-V Intellectual Disability
Definition
DSM-IV
Mental retardation is a developmental condition that is characterized by significantly lower than average level of general intellectual functioning.
Failure to develop cognitive abilities and achieve an intelligence level that would be appropriate for their age group.
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
Definition
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
DSM-V
Intellectual Disability is a disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social, and practical domains. (APA, 2013)
Mental Retardation Diagnostic Criteria
1. Intellectual functioning significantly below average. IQs of about 70 or lower
2. Impairments or deficits for that age group in functioning in at least two of the following areas:
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
Mental Retardation Diagnostic Criteria
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
Communication
Self-care
Home living
Social and interpersonal skills
Functional academic skills
Use of community resources
Self-direction
Leisure
Work
Health and safety
3. Onset before age 18
Severity Level
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
Level
IQ
Mild
50-70
Moderate
35-49
Severe
20-34
Profound
< 20
Severity Level
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
Cause
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
Unknown Genetic factor - Down syndrome - Tuberous sclerosis - PKU
Environment - Low socio-economic status - Inadequate caretakers - Child abuse
Postnatal - Meningitis - Encephalitis - Accidents - Poisoning
Prenatal - Rubella - Syphilis - Herpes simplex - HIV - Alcohol - Amphetamine Perinatal
- Prematurity - Birth asphyxia - Hyperbilirubinemia
Cause
Treatment
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
Physical illness & Mental illness
Counseling: Individual & Family
Certificate of disability
Education
Assessment
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
Physical development
Language development
Social development
Self-care ability
Intellectual ability
Education
Impulse control
Nursing Diagnosis
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
Delayed growth and development related to cognitive or perceptual impairment
Self-care deficit related to cognitive or perceptual impairment
Ineffective relationship related to developmental delay
Impaired verbal communication related to developmental delay
Ineffective coping related to learning disability
NANDA Nursing Diagnosis (Ackley & Ladwig, 2014)
Nursing Intervention
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
Family counseling & Family psychoeducation: Disease, Health care
Promotion of developmental
Environment
Therapeutic relationship
Physical therapy
Activity therapy
Speech therapy
Rehabilitation: Education, Occupational
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Autistic Disorders
Definition
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
Autism Disorders or autism is marked impairment in reciprocal social interaction and verbal and nonverbal communication with a restrictive and repetitive activities and interest. (Tanguay, 2010 cited in Boyd, 2012: 681)
Cause
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
Biological factors genetic/familial factors
Brain
neurotransmitter: Serotonin Endorphins Dopamine Sulfate
Immunology factor
Gestational/Perinatal/Postnatal
Psychological factors Parenting raising
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Impairment in social
interaction
Verbal and Non-verbal
communication
Restricted, repetitive and
stereotypic behaviors and
interests
Clinical
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
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“ไม่สบตา ไม่พาที ไม่ช้ีน้ิว”
Diagnostic Criteria
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
A. A total of six (or more) items from (1) (2) and (3) with at least
two from (1) and one each from (2) (3)
(1) Social interaction Impaired nonverbal behavior
Lack of peer relationships
Lack of spontaneous social engagement
Lack of social and emotional reciprocity
Diagnostic Criteria
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
(2) Communication Absence or delay of spoken language
Pragmatic difficulties
Stereotyped or idiosyncratic language
Lack of imaginative or imitative play
(3) Behavior & Interests Abnormally restricted interests
Inflexible routines and rituals
Motor mannerisms
Preoccupation with parts of objects
Diagnostic Criteria
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years:
(1) Social interaction
(2) Language as used in social communication
(3) Symbolic or imaginative play
C. The disturbance is not better accounted for by Rett’s Disorder or Childhood Disintegrative Disorder
Treatment
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
Developmental therapy: Behavior, Speech, Education
Medication: Antipsychotic Drugs, Antidepressant Drugs, Antianxiety Drugs, Anticonvulsant Drugs, Vitamin B6
Assessment
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
Developmental delays, uneven development, or loss of acquired abilities.
The parent-child relationship for evidence of bonding, anxiety, tension, and fit of temperaments.
Physical and emotional signs of possible abuse. Be aware that children with behavioral and developmental problems are at risk for abuse
Knowledge about community programs providing support services for parents and children, including parent education, counseling, and after-school programs
(Halter, 2014: 192)
Nursing Diagnosis
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
NANDA Nursing Diagnosis (Ackley & Ladwig, 2014)
Impaired verbal communication related to speech and language delays
Impaired social interaction related to inability to relate to others
Risk for self-directed or other-directed violence related to lack of impulse control
Risk for delayed development related to autism
Nursing Intervention
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
Safety
Developmental therapy
Family counseling
Play therapy
Behavior therapy
Family therapy
Milieu therapy
Nutritional therapy
Psychoeducation
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Attention Deficit Hyperactivity Disorder: ADHD
วิทยาลยัพยาบาลและสขุภาพ มหาวิทยาลยัราชภฏัสวนสนัุนทา อาจารยจิ์ราพร รกัการ
Definition
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
DSM-V
ADHD as a persistent pattern or inattention and/or hyperactivity-impulsivity that interferes with functioning or development, has symptoms presenting in two or more setting.
Negatively impacts directly on social, academic or occupational.
Several symptoms must have been present before age 12 years. (APA, 2013)
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Cause
Genetic factors
Biological factors
Social & environment
factors
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
- Fidget and squirm when seat - Doesn’t stay seated - Get up frequently to walk or run around
- Disorganization - Lack of focus - Difficulty giving attention to details
- Impatience - Having a hard time waiting to talk or react - Blurt out answers before someone finishes asking them a question
Hyperactivity Inattention Impulsivity
Clinical Characteristics
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
Diagnostic Criteria
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
A. Six (or more) of the following symptoms at least 6 months
(1) Inattention Fails to give close attention to details
Has difficulty sustaining attention in tasks or play activities
Does not seem to listen
Fails to finish
Has difficulty organizing tasks and activities
Avoids sustained effort
Loses things necessary for tasks or activities
Easily distracted by extraneous stimuli
Forgetful in daily activities
Diagnostic Criteria
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
(2) Hyperactivity/Impulsivity Fidgets with hands or feet or squirms in seat
Leaves seat in classroom
Runs or climbs
Unable to play or engage in leisure activities quietly
Motor excess
Talk excessively
Blurts out answers before a question has been completed
Has difficulty awaiting their turn
Interrupts or intrudes on others
Diagnostic Criteria
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
B. Present before age 7 years
C. Present in two or more setting
D. The symptoms interfere the quality of social, academic, or occupational
E. The symptoms do not occur exclusively during the course of developmental disorder, schizophrenia, or other psychotic disorder
Treatment
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
Family intervention: Psychoeducation,
Parent management training
School intervention
Medication: Methylphenidate (RitalinR, RubifenR)
Assessment
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
Level of physical activity
Attention span
Talkativeness
Frustration tolerance
Impulse control
Ability to follow directions and complete tasks
Developmental variance in these behaviors
Assessment
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
Social skills
Friendship history
Problem-solving skills
School performance
Academic failure and poor peer relationships lead to
low self- esteem, depression
Associated comorbidities: Anxiety & Depression
Nursing Diagnosis
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
NANDA Nursing Diagnosis (Ackley & Ladwig, 2014)
Ineffective impulse control related to disorder of development
Impaired social interaction related to impulsive behavior
Chronic low self-esteem related to difficult in participating in expected
activities
Risk for self-directed or other-directed violence related to lack of
impulse control
Disable family coping related to significant person with chronically
unexpressed feelings of guilt, anxiety, and despair
Nursing Intervention
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
Family counseling
Safety
Environment
Behavior therapy
Therapeutic relationship
Counseling
Psychoeducation
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Conduct Disorders: CD
Definition
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
The main features of conduct disorder are repetitive and persistent patterns of behavior in which the rights of others or social rules are consistently violated.
(APA, 2002)
Children with this disorder are aggressive, deceptive, and destructive with these symptoms begin the primary reason for psychiatric referral.
(O’Brien, Kennedy and Ballard, 2013: 284)
Cause
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
Biological factors Genetic
Neurotransmitter: Dopamine
Hormones: testosterone androstenedione
Environment factors Low Economic
Parental Drugs abuse
Child Abuse
Homelessness
Diagnostic Criteria
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
A. Three of the following present within last 12 months and at least one within last 6 months
(1) Aggression to people and animal Bullies, threatens, or intimidates to others
Initiates physical fights
Used a weapon that can cause serious physical harm to others
Cruel to people
Cruel to animals
Stolen while confronting a victim
Forced someone into sexual activity
Diagnostic Criteria
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
(2) Destruction of property/Deceitfulness of theft Engaged in fire setting
Destroyed other’s property
Broken into someone else’s house, building, or car
Lies to obtain goods or favors to avoid obligations
Stolen items of nontrivial value without confronting a victim
(3) Serious violations of rules Stays out at night despite parental prohibitions, beginning before age 13 years
Run away from home overnight at least twice while living in parental
Truant from school, beginning before age 13 years
Diagnostic Criteria
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
B. The disturbance in behavior causes clinically significant impairment in social, academic or occupational function
C. If the individual is age 18 years or older, criteria are not met for antisocial personality disorder.
Treatment
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
Behavior therapy
Family therapy
Medication: Antipsychotic drugs, Lithium, Anticonvulsant drugs
Assessment
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
The seriousness of the disruptive behavior; determine when it started and what has been done to manage it.
The levels of anxiety, aggression, anger, and hostility
The ability to control impulses
Moral development for the ability to understand the effect of hurtful behavior on others, to empathize with others, and to feel remorse or guilt
Negative thoughts
Nursing Diagnosis
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
NANDA Nursing Diagnosis (Ackley & Ladwig, 2014)
Ineffective impulse control
Ineffective coping
Ineffective relationship
Impaired social interaction
Risk for other-directed violence
Nursing Intervention
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
Therapeutic relationship
Family counseling
Family psychoeducation
Behavior therapy
Positive & Negative reinforcement
Relaxation technique
Self-awareness
ฉววีรรณ สตัยธรรม, แผ จนัทรส์ุข และศุกรใ์จ เจรญิสุข. (2556). การพยาบาลจติเวชและสุขภาพจติ (ฉบบัปรบัปรงุ) เล่มที ่2. กรงุเทพมหานคร: ธนาเพรส.
ทวศีกัดิ ์สริริตัน์เรขา. (2556). ออทสิตกิ. สบืคน้เมือ่ 15 กนัยายน 2559, จาก http://www.dmh.go.th/downloadportal/Morbidity/Autistic.pdf
มนสัว ีจ าปาเทศ และศุกรใ์จ เจรญิสุข. (2556). การพยาบาลจติเวชเดก็ (Child Psychiatric Nursing). ใน ฉววีรรณ สตัยธรรม, แผ จนัทรส์ุข และ
ศุกรใ์จ เจรญิสุข (บรรณาธกิาร), การพยาบาลจติเวชและสุขภาพจติ (ฉบบัปรบัปรงุ) เล่มที ่2 (หน้า 179-211). กรงุเทพมหานคร: ธนาเพรส.
มาโนช หล่อตระกูล และปราโมทย ์สุคนิชย.์ (2555). จติเวชศาสตร ์รามาธบิด.ี (พมิพค์รัง้ที ่3). กรงุเทพมหานคร: ภาควชิาจติเวชศาสตร ์คณะแพทยศาสตร ์
โรงพยาบาลรามาธบิด ีมหาวทิยาลยัมหดิล.
ศริไิชย หงษ์สงวนศร.ี (2555). ความผดิปกตทิางจติเวชเดก็และวยัรุ่น. ใน มาโนช หล่อตระกูล และปราโมทย ์สุคนิชย ์(บรรณาธกิาร), จติเวชศาสตร ์รามาธบิด ี
(หน้า 433-439). (พมิพค์รัง้ที ่3). กรงุเทพมหานคร: ภาควชิาจติเวชศาสตร ์คณะแพทยศาสตร ์โรงพยาบาลรามาธบิด ีมหาวทิยาลยัมหดิล.
สุวรรณ ีพุทธศิร.ี (2555). Attention Deficit and Disruptive Behavior Disorder. ใน มาโนช หล่อตระกูล และปราโมทย ์สุคนิชย ์(บรรณาธกิาร), จติเวชศาสตร ์
รามาธบิด ี(หน้า 461-468). (พมิพค์รัง้ที ่3). กรงุเทพมหานคร: ภาควชิาจติเวชศาสตร ์คณะแพทยศาสตรโ์รงพยาบาลรามาธบิด ี มหาวทิยาลยัมหดิล.
Ackley, B. J. & Ladwig, G. B. (2014). Nursing Diagnosis Handbook: An Evidence-Base Guide to Planning Care. (10th ed.). Maryland Heights, MO: Elsevier Mosby.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. (5th ed). Washington DC: American Psychiatric Association.
Boyd, M. A. (2012). Psychiatric Nursing: Contemporary Practice. (5th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Halter, M. J. (2014). Varcarolis’ Foundations of Psychiatric Mental Health Nursing: A Clinical Approach. (7th ed.). St. Louis, MS: Elsevier Saunders.
O’Brien, P. G., Kennedy, W. Z., & Ballard K. A. (2013). Psychiatric Mental Health Nursing. (2nd ed). Burlington, MA: Jones & Bartlett Learning.
Stuart, G. W. (2013). Principles and Practice of Psychiatric Nursing. St. Louis, MS: Elsevier Saunders.
Varcarolis, E. M. (2013). Essentials of Psychiatric Mental Health Nursing. St. Louis, MS: Elsevier Saunders.
Videbeck, S. L. (2014). Psychiatric-Mental Health Nursing. (6th ed). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Reference
College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn
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