NURS6660 Week 11 Discussion: Special Topics in Child and Adolescent Psychiatry

Discussion: Special Topics in Child and Adolescent Psychiatry Many children face special issues that impact everyday life, whether it is within themselves, their families, or their environment. The PMHNP must be sensitive to these many issues that children and adolescents are faced with during important developmental years. In this Discussion, you select a special population and analyze the psychological issues that the population faces. You also address the assessment and treatment needs of the population. Learning Objectives Students will: Analyze psychological issues that may arise in children faced with special circumstances Evaluate assessment measures used with children faced with special circumstances Evaluate treatment options used with children faced with special circumstances Analyze cultural influences on treatments (D) To Prepare for the Discussion: Review the Learning Resources. Select one of the following topics for the Discussion: Adoption Foster care Gender dysphoria Forensic issues Impact of terrorism on children Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click submit, you cannot delete or edit your own posts and cannot post anonymously. Please check your post carefully before clicking Submit! By Day 3 Post: Write your selected disorder in the subject line of your Discussion post. Explain the psychological issues that may result from your topic. Describe the most effective assessment measure that could be used, and explain why you selected this. NURS6660 Week 11 Discussion: Special Topics in Child and Adolescent Psychiatry. Explain the treatment options available for children and adolescents involved with your selected disorder. Explain how culture may influence treatment. Learning Resources Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus. Required Readings American Nurses Association. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). Washington, DC: Author. Standards 11 “Communication” (page 75) Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer. Chapter 31, “Child Psychiatry” (pp. 1279–1323) American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. “Somatic Symptom and Related Disorders” “Other Conditions That May Be a Focus of Clinical Attention” “Assessment Measures” “Cultural Formulation” Note: You will access this book from the Walden Library databases. American Academy of Child & Adolescent Psychiatry (AACAP). (2011). Practice parameter for child and adolescent forensic evaluations. Journal of the American Academy of Child & Adolescent Psychiatry, 50(12), 1299-1312. Retrieved from http://www.jaacap.com/article/S0890-8567(11)00883-5/pdf American Academy of Child & Adolescent Psychiatry (AACAP). (2012c). Practice parameter on gay, lesbian, or bisexual sexual orientation, gender nonconformity, and gender discordance in children and adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 51(9), 957–974. Retrieved from http://www.jaacap.com/article/S0890-8567(12)00500-X/pdf Lee, T., Fouras, G., & Brown, R. (2015). Practice parameter for the assessment and management of youth involved with the child welfare system. Journal of the American Academy of Child & Adolescent Psychiatry, 54(6), 502–517. Retrieved from http://www.jaacap.com/article/S0890-8567(15)00148-3/pdf Human Rights Campaign. (n.d.). Growing up LGBT in America. Retrieved June 8, 2017, from http://assets.hrc.org//files/assets/resources/Growing-Up-LGBT-in-America_Report.pdf?_ga=1.83582870.1279387255.1493224749 Optional Resources Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Hoboken, NJ: Wiley Blackwell. Chapter 19, “Legal Issues in the Care and Treatment of Children With Mental Health Disorders” (pp. 239–249) Chapter 49, “Forensic Psychology” (pp. 636–647) NURS6660 Week 11 Discussion: Special Topics in Child and Adolescent Psychiatry.

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Discussion: Special Topics in Child and Adolescent Psychiatry

Introduction

One of the major issues facing the children and adolescent population is adoption.  In context, adoption is the process of assuming the role of a parent to a child. The person assuming parenthood permanently transfers the roles, responsibilities, and rights together with a filiation from the legal or biological parents of the child (American Nurses Association, 2014). This process has led to many psychiatric issues and disorders among the adopted children and adolescents as they struggle to cope and interact with their newly found family members. This is one of the special issues that impact the everyday life of this population within themselves, their families, or their environment as they develop.

Reactive Attachment Disorder (RAD) among Adopted Children and Adolescents      

One of the major disorder facing adopted children and adolescents is reactive attachment disorder (RAD). This is a disorder associated with the difficulty which the adopted children and adolescents face in their new environment (American Psychiatric Association, 2013). RAD makes this population uncomfortable with their new environment and shows resistance to any effort by the caretakers to show them comfort. This population develops RAD due to the lack of sufficient nurturing, consistent care, and comfort while under their adopted parents.

It is important to note that the RAD makes the adopted children and adolescents susceptible to psychological issues such as anxiety, low self-esteem, depression, self-harm, struggle with academic performance, negative behavioral development, and lack of meaningful relationships (Thapar, Pine, Leckman, et al., 2015). RAD is a major concern for the adopted children and adolescents because its related psychological issues have a major impact on one’s identity, place in the social environment, passion, and purpose. RAD also makes the adopted children and adolescents begin questioning where they came from, why they had to be adopted, whether they fit into the new system, and whether they have been accepted into their new families. The uncertainty over their adulthood also makes them have depression, anger and stress leading to resentment.

The Psychological Issues that Adopted Children and Adolescent Psychiatry Faces

Adopted children and adolescents face a number of psychological issues that may have an implication to their development either individually, within their new families, or in the external environment where they interact with others (American Psychiatric Association, 2013). The environmental factors associated with adoption and the genetic factors make the adopted children prone to externalizing disorders. The adopted children and adolescents usually develop under a unique relationship with their new found parents that leads to emotional and mental issues as they struggle to adapt to their new environment.

Attachment and mental health issues are also common psychological issues among the adopted children and adolescents. Adopted children and adolescents are always worried about abandoning their own home, family and the ordinary life they are used to. They are also worried about getting incorporated into a totally strange family with new members (Thapar, Pine, Leckman, et al., 2015).  NURS6660 Week 11 Discussion: Special Topics in Child and Adolescent Psychiatry.They face difficulty when identifying their perfect social group in case of different cultural backgrounds from that of their adopted families.

Adopted children and adolescents also face the psychological issue of uncertainty over their heritage and identity when they find themselves in social groups with a common culture or heritage that conflicts with that of their former families.in most cases, this population remains anxious over the future affecting their attachment to the newly found parents (Lee, Fouras & Brown, 2015). The major psychological issue among this population is laxity to cope with changes within the family dynamics. Therefore, they always have mood swings, show signs of anger, and are always irritated.

The Effective Assessment Measure for Reactive Attachment Disorder among Adopted Children and Adolescents

            RAD can be effectively measured in line with the provision of DSM-IV by taking the history of pathogenic care during the period which the adopted child or adolescent was under the care of the new parents. A checklist and a series of 3 questionnaires developed with specific scales and structured observation may be used to measure RAD in this population (AACAP, 2012). This is accompanied with a comprehensive examination of the attachment presented by the child or adolescent as well as the history of relationship with caregivers. The two rating scales used to conduct an effective assessment measure for RAD among this population are the Reactive Affective Disorder Checklist (RAD-C) and the Relationships Problem Questionnaire (RPQ) all designed in compliance with the DSM-IV-TR criteria.

The DSM-IV-TR criteria look at any instance of having experiences with an unstable caregiver as well as a disregard to the psychological and emotional needs of this population to assess the presence of RAD (Lee, Fouras & Brown, 2015). The assessment must also look at the lack of affection and simulation which may be attributed to the lack of attachment to the primary caregiver and challenges with social relatedness. Also, the assessment must measure the level of disturbance and inappropriate development in respect to social relations. NURS6660 Week 11 Discussion: Special Topics in Child and Adolescent Psychiatry.

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The Effective Treatment Options for the Adopted Children and Adolescents

RAD can be treated by focusing on helping this population overcome the struggle with self-harm, addiction, insecure attachment, depression, and anxiety. They must be encouraged to engage in intimacy to create close emotional connections within their social circles. DSM-IV provides an intensive treatment option lasting for 45 days targeting the attachment disorders (AACAP, 2012). This treatment option is safe and nurtures the population to recover from RAD by addressing the underlying causes of RAD. This treatment option aims at helping the individuals to face difficult issues, and become accountable for their recovery process, behaviors, and feelings.

How Culture May Influence Treatment

In case the adopted child or adolescent has a different cultural background from that of the new family, it would be important to embrace a multicultural treatment option to help the individual to effectively overcome the challenges (AACAP, 2011). The treatment plan should, therefore, take into consideration psychological issues such as the child’s heritage, parents, and history of the biological family cause discomfort and frustration among the adopted children and adolescents. NURS6660 Week 11 Discussion: Special Topics in Child and Adolescent Psychiatry.

References

American Nurses Association. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). Washington, DC: Author. (page 75)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

American Academy of Child & Adolescent Psychiatry (AACAP). (2011). Practice parameter for a child and adolescent forensic evaluations. Journal of the American Academy of Child & Adolescent Psychiatry, 50(12), 1299-1312. Retrieved from http://www.jaacap.com/article/S0890-8567(11)00883-5/pdf

American Academy of Child & Adolescent Psychiatry (AACAP). (2012c). Practice parameter on gay, lesbian, or bisexual sexual orientation, gender nonconformity, and gender discordance in children and adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 51(9), 957–974. Retrieved from http://www.jaacap.com/article/S0890-8567(12)00500-X/pdf

Lee, T., Fouras, G., & Brown, R. (2015). Practice parameter for the assessment and management of youth involved with the child welfare system. Journal of the American Academy of Child & Adolescent Psychiatry, 54(6), 502–517. Retrieved from http://www.jaacap.com/article/S0890-8567(15)00148-3/pdf

Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Hoboken, NJ: Wiley Blackwell.  NURS6660 Week 11 Discussion: Special Topics in Child and Adolescent Psychiatry.