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UNIT VII • Care of Children and Adolescents

member through death, divorce, or military deployment. In other situations, the arrival of a new family member may precede the child’s separation anxiety. A family assessment is important in determining the relationship of the child’s fears and anxiety and the family dynamics. Teamwork and Collaboration: Working Toward Recovery An interdisciplinary approach is needed for the treatment of separation anxiety disorder. Effective treatment includes child and parent psychoeducation, school consultation, CBT, and if severe, selective serotonin reuptake inhibitors (SSRIs) (Giani et al., 2022; Tekin & Aydin, 2022). EVIDENCE-BASED NURSING CARE FOR CHILDREN WITH SEPARATION ANXIETY DISORDER School refusal is often what prompts the family to seek consultation for the child. Because school refusal can be a behavioral manifestation of several different child psy chiatric disorders, it requires careful assessment. Issues to consider are whether the parents have been aware that the child is avoiding school (separation anxiety vs. tru ancy); what efforts the family has used to return the child to school; the presence of significant subjective distress in the child with anticipation of going to school; and whether the school refusal occurs in the context of other behavioral, social, or emotional issues. The nurse should also review the purpose and dose of current medications. The child’s developmental history and response to new situations and prior separations provide essential back ground information for understanding the child’s current separation anxiety. The assessment should also include a review of recent life events and the methods the family has used to promote the child’s return to school. Finally, the family history with respect to anxiety, panic attacks, or phobias is also informative. Nursing priorities will depend on the role of the nurse (school nurse, acute care, or community practice) and the relationship with the child and family. In some instances, the nurse will be responsible for education of the child and family. If the child is receiving medication, nursing care related to administration of medications and educa tion should be implemented. Nurses will also be involved in educating teachers and serving as a liaison between treating providers, family and child, and school. OBSESSIVE-COMPULSIVE DISORDER OCD is characterized by intrusive thoughts that are dif ficult to dislodge (i.e., obsessions) or ritualized behaviors that the child feels driven to perform (i.e., compulsions) (see Chapter 28). Children tend to exhibit both multiple

obsessions and compulsions that relate to fear of cata strophic family event, contamination, sexual or somatic obsessions, and overly moralistic thoughts. Washing, checking, repeating, and ordering are the most com monly reported compulsions (Geller, 2022; Schuyler & Geller, 2023). Epidemiology and Etiology The prevalence rate of OCD is estimated at 1% to 2% with two peaks of incidence across the lifespan, one occur ring in preadolescent children and later a peak in early adult life. More than half of the cases of OCD in youth involve a comorbid psychiatric disorder, with ADHD, conduct disorders, autism spectrum disorder, and Tourette syndrome being most frequent, particularly in males. The etiology of OCD in children is thought to be similar to that of adults (see Chapter 28). However, there is a subset of children whose OCD behavior may be related to an immune response to group A beta-hemolytic streptococ cal infections that led to inflammation of the basal ganglia (Schuyler & Geller, 2023; Vreeland et al., 2023). Family Response to Disorder Pediatric OCD often impacts a child’s entire family unit. Family plays an important role in the maintenance of OCD, and parents’ responses to their child’s obsessions and compulsions depend on their understanding of the thoughts and behaviors. Family accommodation—that is, when family members participate in the child’s OCD related symptoms and behaviors—is intended to be helpful but is ultimately counterproductive. For example, when a family member gives frequent reassurance, facili tates the child’s rituals, assists with avoidance, and modi fies routines around symptoms, they unintentionally rein force reliance on the obsessive-compulsive behaviors and family help. Parents need education and support to help their child (Chessell et al., 2023; Schuyler & Geller, 2023). Teamwork and Collaboration: Working Toward Recovery Interdisciplinary treatment including school personnel is important for the child and family with OCD. SSRIs and CBT, including psychoeducation, cognitive training, exposure and response preventions, and relapse preven tion, are the treatment of choice (Schuyler & Geller, 2023). EVIDENCE-BASED NURSING CARE FOR CHILDREN WITH OCD Recurrent worries and ritualistic behavior can occur in children at particular stages of development. The first step in the assessment of OCD in children is to

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