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UNIT VII • Care of Children and Adolescents

INTELLECTUAL DEVELOPMENTAL DISORDER Intellectual developmental disorder, also known as intel lectual disability, is a condition characterized by significant limitations in both intellectual function and in adaptive behavior that originates during the developmental period before the age of 22 (American Association on Intellectual and Developmental Disabilities [AAIDD], 2024). Diagnostic Criteria and Clinical Course The diagnosis of intellectual developmental disorder involves an assessment of intellectual function such as rea soning, problem-solving, and adaptive function in personal independence and social responsibility (AAIDD, 2024). A diagnosis is made through clinical assessment of behavioral features; historical accounts from parents and teachers; and performance on standardized tests such as the Stanford– Binet or the Wechsler Intelligence Scales for Children. The usual threshold for intellectual developmental disorder is an intelligence quotient (IQ) of 70 or less (i.e., two standard deviations below the population mean). Adaptive behavior is composed of three skill types: conceptual skills (e.g., language and literacy, money, time, number concepts, and self-direction); social skills (e.g., interpersonal skills, social responsibility, self-esteem, gull ibility, social problem-solving, and the ability to follow rules and obey laws and to avoid being victimized); and practical skills (e.g., activities of daily living [ADLs], occupational skills, health care, travel and transportation, schedules and routines, safety, use of money, and use of telephone). Although standardized tests may help to deter mine impaired adaptive functioning, this determination is primarily a clinical judgment based on the child’s capacity to manage age-appropriate ADLs (AAIDD, 2024). An intellectual developmental disorder is not necessar ily lifelong. Some children may be diagnosed at school age as having an intellectual disability, but their level of life functioning may improve with sustained individual ized support. Epidemiology and Etiology The prevalence of intellectual disabilities to be about 3% in the United States and worldwide. A considerable vari ability exists worldwide, with low- and middle-income countries reporting significantly higher rates of disabil ity than high-income countries (Olusanya et al., 2023). Children and adolescents with intellectual developmental disorder are at higher risk for developing co-occurring mental health conditions, including major depression, bipolar disorder, anxiety disorders, psychotic illnesses, impulse control disorders, and others. ADHD is present in approximately 39% of children with intellectual dis ability. Such children are also more likely to have medical

(11.4%), behavior issues (7.4%), anxiety (10%), and depres sion (4%) (Centers for Disease Control and Prevention [CDC], 2024a). One in five children and adolescents reports the pandemic having a significant negative impact on their mental health (NAMI, 2024). Unfortunately, despite this prevalence, significant gaps in treatment exist, particularly for children in low-income, underrepresented, and underserved communities (Chang & Slopen, 2024; Ilori et al., 2024). This chapter presents an overview of selected child hood disorders and discusses nursing care for children and their families with these issues. Because it is beyond the scope of this text to present all child psychiatric disorders, this chapter discusses selected ones, including neurodevelopmental disorders ( intellectual develop mental disorder, autism spectrum disorder [ASD] , and ADHD), disruptive behavior disorders (oppositional defiant and conduct disorders), tic disorders, separation anxiety disorder, and obsessive-compulsive disorder (OCD), mood disorders, childhood schizophrenia, and elimination disorders ( enuresis and encopresis ). NCLEXNOTE All psychiatric disorders of childhood and adolescence should be viewed within the context of growth and development models. Safety and self-esteem are priority considerations. NEURODEVELOPMENTAL DISORDERS OF CHILDHOOD THAT CAUSE SIGNIFICANT DELAY IN DEVELOPMENT Neurodevelopmental disorders occur early in a child’s development, often before beginning grade school. These disorders affect cognitive and developmental functioning resulting in deficits that range from very specific limita tions of learning to global impairments of social skills. They impact personal, social, academic, or behavioral functioning. Under the primary influences of genes and environment, neurodevelopment of attention, cognition, language, affect, and social and moral behavior proceeds along several pathways. Developmental pathways and developmental delays are closely interwoven. For exam ple, a language delay can interfere with a child’s social development and contribute to difficulties in behavior and emotions (Abin et al., 2024; Tamayo et al., 2024). This section reviews neurodevelopmental disorders of childhood that include several conditions that are etio logically unrelated; however, their common feature is a significant delay in one or more lines of development. KEYCONCEPT Neurodevelopmental delay means that the child’s development in attention, cognition, language, affect, and social or moral behavior is outside the norm and is manifested by delayed socialization, communication, peculiar mannerisms, and idiosyncratic interests.

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