Boyd 8e

787

CHAPTER 37 • Mental Disorders of Childhood and Adolescence

conditions that are overlooked because they are less able to localize pain, describe symptoms, or provide other assessment data (Pinals et al., 2022; Totsika et al., 2022). Intellectual disabilities result from a variety of causes with the most common etiology related to genetic syn dromes. Chromosomal changes or defects (e.g., Down syndrome) and exposure to toxins during prenatal devel opment (e.g., fetal alcohol syndrome), heredity, pregnancy and perinatal complications, medication conditions, and environmental influences are all associated with intellec tual disabilities (Shaffer et al., 2023; Tartaglione et al., 2024; van Wijngaarden et al., 2024). EVIDENCE-BASED NURSING CARE OF CHILDREN WITH INTELLECTUAL DEVELOPMENTAL DISORDER Person-centered care of a child with intellectual develop mental disorder focuses on their strengths, capability, and ability to contribute to their community instead of their deficits. Nursing assessment focuses on current adaptive skills, intellectual status, and social functioning. A devel opmental history is a useful way to gather information about past and current capacities (Box 37.1). The nurse compares these data with typical growth and develop ment. Developmentally delayed children who have not had a psychological evaluation should be considered for referral. Children with intellectual developmental disor der also require evaluation for other comorbid psychiat ric disorders, which may be a challenge because of the child’s cognitive limitations. Discussions about feelings and behavior may be too complex for these children. If children or adolescents with intellectual disabilities have a comorbid psychiatric disorder or serious behavioral issues, a carefully constructed interdisciplinary behavioral plan will guide care and treatment.

The nurse also assesses the child’s support systems (family, school, rehabilitative, and psychiatric) to ensure that the child’s special needs have been identified and are being addressed. For example, occupational therapy may be recommended to improve motor coordination, but the family may not have transportation to these services available, so availability of alternative services should be explored. The child and family’s response to intellectual disabil ity and other comorbid conditions will determine the nursing interventions. Interventions most often include promoting coping skills (i.e., interventions directed at building strengths, adapting to change, and maintaining or achieving a higher level of functioning), patient edu cation, and parent education. The overall goals of treatment and nursing care are an optimal level of functioning for the family and eventual independent functioning within an expected social envi ronment for the child. For many children with intellec tual disability, achieving independence in adulthood will be delayed but possible. Continuum of Care Children and families require varying levels of interven tions at different times throughout the life cycle, with an ultimate goal to increase self-direction and promote full community inclusion. When a child is young, the family requires special educational support and, for some, res idential services. The need for psychiatric intervention varies according to the severity of disability, family func tioning, and the coexistence of other disorders. Feelings of grief and uncertainty in family members (especially parents) related to having a child with a disability may be relieved through family therapy. More specific parent training may be needed to deal with emerging maladaptive behaviors. See Clinical Judgment Nursing Care Plan 37.1. AUTISM SPECTRUM DISORDER ASD is characterized by persistent impairment in social communication and social interaction with others, and restricted and repetitive behaviors (APA, 2022). Children with ASD may or may not have an intellectual disability, but they commonly show an uneven pattern of intellec tual strengths and limitations. This condition may be a lifelong pattern of being rigid in manner, intolerant of change, and prone to behavioral outbursts in response to environmental demands or changes in routine. Two conditions, autism disorder and Asperger syndrome, were previously diagnosed as separate disorders. However, because they have many overlapping symptoms and are difficult to differentiate from each other. The DSM-5- TR no longer considers autism and Asperger syndrome as separate disorders but considers both as an ASD differen tiated by language or intellectual impairment (APA, 2022).

BOX 37.1 History and Hallmarks of Childhood and Adolescent Disorders

• Maternal age and health status during pregnancy • Exposure to medication, alcohol, or other substances during pregnancy • Course of pregnancy, labor, and delivery • Infant’s health at birth • Eating, sleeping, and growth in first year • Health status in first year • Interest in others in first 2 years • Motor development

• Mastery of bowel and bladder control • Speech and language development • Activity level • Response to separation (e.g., school entry)

• Regulation of mood and anxiety • Medical history in early childhood • Social development • Interests

Copyright © 2026 Wolters Kluwer, Inc. Unauthorized reproduction of this content is prohibited.