Boyd 8e

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UNIT VII • Care of Children and Adolescents

remedial services in the least restrictive educational set ting. Families occasionally need help in advocating for these services. The same is true for children with communication dis orders, although the services requested may be different. Speech pathologists conduct the diagnostic assessment of speech and language disorders. Nurses may be involved with formal screening for communication disorders. Services such as speech therapy (directed at the motor aspects of speaking) or social skills groups (directed at the social and interpersonal aspects of language) are often available in school districts and can be obtained if a speech or language disorder has been identified. For some children with communication disorders, the ser vices offered by the school may be insufficient. In such cases, the nurse can help the family locate a facility that can provide these needed services. DISRUPTIVE BEHAVIOR DISORDERS Disruptive behavior disorders , which include opposi tional defiant disorder and conduct disorder, are condi tions marked by significant issues of conduct. Behaviors associated with these disorders violate the rights of others and/or are in conflict with societal norms (APA, 2022). OPPOSITIONAL DEFIANT DISORDER AND CONDUCT DISORDER Oppositional defiant disorder (ODD) is characterized by a persistent pattern of disobedience, argumentative ness, angry outbursts, low tolerance for frustration, and tendency to blame others for misfortunes, large and small. Children with oppositional defiant disorder are more likely to demonstrate oppositional behavior with people they know, such as family members or school teachers. Although it is not uncommon for all children to test limits at times, children with ODD do this more often than others their age. Their behaviors lead to issues with making friends with their peers, and they often find themselves in conflict with adults. ODD typically begins before the age of 8, and generally no later than 12 years old. Some children with ODD will develop conduct dis order (CDC, 2024e). Conduct disorder (CD) is characterized by more serious violations of social norms, including aggressive behavior (such as bullying and fighting), destruction of property, and cruelty to animals. Conduct disorder generally occurs later than ODD, most often in adoles cence. Children and adolescents with conduct disorder often lie to achieve short-term ends, may be truant from school, may run away from home, and may engage in breaking the law, resulting in arrest (CDC, 2024e). See Box 37.8.

Epidemiology Children and adolescents with disruptive behavior disor ders frequently present to psychiatric treatment settings. The estimated global prevalence rate of conduct disorder in children and adolescents is 3%, with a rate 2.6 times higher in males than females. The disorder appears to be fairly consistent across various countries that differ in race and ethnicity (Ayano et al., 2024). Males with con duct disorder frequently are involved in fighting, stealing, vandalism, and school disciplinary issues. Females with the diagnosis are more likely to practice lying, truancy, running away, substance use, and prostitution. Whereas males tend to exhibit both physical aggression and rela tional aggression (i.e., behaviors that harm social rela tions of others), females tend to exhibit relatively more relational aggression (APA, 2022). Conduct disorder is a frequently diagnosed disorder in children in mental health facilities. Individuals with conduct disorder are at risk for comorbid substance use disorders, anxiety, and depressive disorders (Jandac & Lenka, 2024). Leon was born in Puerto Rico and is the oldest of three children. His family moved to the mainland shortly after his birth, and the primary language at home is Spanish. His father is employed as a janitor and speaks very little English. His mother works as a secretary and has achieved fairly good command of English. He has received no treatment except for consultation with the school social worker. Building Clinical Judgment 1. When conducting a nursing assessment, what would you want to learn about Leon’s school performance? 2. What information could you provide Leon’s parents about pharmacotherapy? About behavior management? BOX 37.8 Clinical Judgment Vignette: Conduct Disorder Leon, age 14, was admitted to the child psychiatric inpa tient service from the emergency department (ED) after a fight with his mother. His mother reported that she and Leon had argued earlier in the evening and that he stormed out of the house screaming and vowing he would never return. Several hours later, Leon came back, yelling, and demanding entry into the apartment. Leon’s father was working. While his mother was getting up to open the door, Leon continued to yell and scream, waking the neighbors. This led to further arguments between Leon and his mother. Before long, the police were called, and Leon was taken to the ED. The admission interview revealed that Leon had run away on several occasions and had even stayed away overnight. Although he strongly denied drug use, he had gotten drunk on several occasions. He had also been in several fights, the latest of which resulted in an expulsion from school. Three months before admission, he was caught trying to steal a video game from an electronics store. More recently, he boasted that he and his friends had snatched a purse at an outdoor concert and had broken into a car to steal its contents. Leon’s school performance has been declining; he was truant on several occasions and will probably have to repeat ninth grade.

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