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Child and Adolescent Mental Health. Donna Poole RN, MSN, CS . Growth and Development in Adolescents. Three phases of Adolescents Early- 10 to 13 Middle- 14 to 17 Late- 17 to 21. Onset of Puberty. Female-lasts 4 years with age of onset from 9 -13.4 Average age is 11.2

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Child and adolescent mental health

Child and Adolescent Mental Health

Donna Poole RN, MSN, CS

Growth and development in adolescents
Growth and Development in Adolescents

  • Three phases of Adolescents

    • Early- 10 to 13

    • Middle- 14 to 17

    • Late- 17 to 21

Onset of puberty
Onset of Puberty

  • Female-lasts 4 years with age of onset from 9 -13.4 Average age is 11.2

  • Growth spurt 1 year prior to breast bud development

  • Peak height achieved 1 year after breast development

  • Menarche begins 1 year after height

  • Epiphyseal closure occurs

Male puberty
Male Puberty

  • Males onset of puberty is 11.6 years of age with a range of 9.5-13.5

  • Puberty lasts 3 years

  • First sign is testicular enlargement

  • Males have a 2 year delay in epiphyseal closure

Cognitive development
Cognitive development

  • Moves from concrete thinking to “formal operations” Abstract thinking

  • Level of thinking allows the person to transfer information from one situation to another, deal efficiently with complex problems, and plan realistically for the future.

Early adolescents
Early adolescents

  • Daydream, spend time in front of a mirror

  • View world as a stage in which they star

  • Very egocentric; see fame and fortune

  • Preoccupied with separation from the family

  • Worry if they are “normal”

Middle adolescents
Middle Adolescents

  • Less grandiose about what they will be

  • Can be issue for “at risk” kids; feel hopeless

  • Not so worried about “normal”

  • Concerned about attractiveness, dating

  • Feelings of omnipotence- reckless behaviors

  • Experiment with morals in both phases

Late adolescents
Late adolescents

  • Develop a sense of self “Who am I”

  • “At Risk” youth may dissociate from family

  • Try on different roles; change majors– etc

  • Gains a sense of perspective, be able to problem solve

  • Consider all aspects of a problem

  • Delay gratification

Mental health problems of school age children
Mental Health Problems of school Age Children

  • 10-13% of children have serious MH problems

  • 655,000 Texas children

  • Case Study

  • The Children’s Partnership

Etiology of mh problems
Etiology of MH Problems

  • Genetics: strong for depression, Anxiety, OCD, Tic disorders, ADHD, bipolar

  • Environment: Abuse and neglect, fetal Alcohol Syndrome, Brain damage

  • Neurological Anomalies

    • Developmental disorders- MR-IQ below 70

    • Pervasive developmental disorders-Autism, Asberger’s, PPD-NOS, Etc.

Developmental disorders and disruptive behavior disorders
Developmental disorders and Disruptive behavior disorders

  • Specific Developmental disorders

    • Learning disorders-dyslexia 3to5% Nonverbal .1 to 1%

    • Communication disorders

  • Disruptive Behavior disorders

    • ADHD; Most common behavoral disorder

    • Oppositional Defiant disorder

    • Conduct disorder

Attention deficit hyperactivity disorder
Attention-deficit Hyperactivity Disorder

  • AD/HD; Classic type

  • ADD without hyperactivity(couch Potato)

  • ADD, Over focused Type(tend to get stuck)

  • ADD, Limbic(negative and irritable

  • ADD, Temporal lobe(Violent, explosive, dark thoughts)

Treatment adhd
Treatment ADHD

  • Problem in the Frontal lobe, which is responsible for planning, attention, regulation of motor activity-Brain under active

  • Medication: Stimulants Ritalin, Dexdrene, Cylert, Adderall

  • Common side effects:Anorexia, weight loss, Tics, abnormal movements, labile mood


  • Keep it simple, structured, and re-enforce good behavior

  • “It is unsafe to jump down stairs 2 at a time” “You walked down the stairs in a safe way”

  • “It is not OK to grab a toy from another child, you must ask”

  • Daily routine & short term rewards/re-enforcers

More interventions
More Interventions

  • Simple instructions; Don’t say-”Clean your room” say- “Put the dirty clothes in the hamper”, Then,” Make your bed”

  • Teaching the family about ADHD

  • Assess family HX and how successful

  • Listen, support groups, books

  • Communicate with teachers, School

Tic disorders
Tic Disorders

  • Tourette’s Syndrome-Movement disorder defined by the presence of motor and phonic tics: Rare 1 to 2 per thousand

  • Motor Tics-rapid, jerky movements of eyes, face, neck, and shoulders

  • Phonic tics: grunting, throat clearing, and repetitive noises

  • Can be words’ obscenities

Psychotic disorders
Psychotic disorders

  • Childhood Schizophrenia-2 cases per 100,000

  • Adolescents-Bipolar, and Schizophrenia