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UNIT VII • Care of Children and Adolescents

essential. Diagnosis of encopresis is presumed, given a history of intermittent constipation and soiling. Collaboration with primary care consultants is often helpful to rule out rare medical conditions, such as Hirschsprung disease. The presence of encopresis does not necessarily signal severe emotional or behav ioral disturbances, but the nurse should inquire about other psychiatric disorders. Psychiatric comorbidities, including attention difficulties, anxiety, and behavioral issues may make encopresis more challenging to treat (Baroud et al., 2022). Effective intervention begins with educating the par ents and the child about expected bowel function and the self-perpetuating cycle of fecal impaction and leakage of stool around the hardened mass of feces. The short term goal of this educational effort is to decrease the anger and recrimination that often complicate the pic ture in these families. Because encopresis often results in a loss of bowel tone, it may help to motivate chil dren by emphasizing the need to strengthen their anal muscles. In many cases, cleaning out the bowel is necessary before initiating behavioral treatment through admin istration of laxatives, rectal suppositories, or enemas. A high-fiber diet and behavior modification is often recommended. The behavioral treatment program involves daily sitting on the toilet after each meal for a predetermined period (e.g., 10 minutes). The child and parents can measure the time with an ordinary kitchen timer. The parents can encourage the child to read or look at pic ture books while sitting. They can give the child rewards in the form of stars, stickers, or points for adhering to the retraining program and add bonuses for successful defecation. The family can tally stickers or points on a calendar, and the child can “cash in” collected points for small prizes. Caring for children with encopresis on an inpatient unit is a challenge, because very little research pro vides direction for positive outcomes. Staff can become frustrated with the child’s seemingly unwillingness to cooperate. Possible interventions include maintaining discretion, assisting children with the development of age-appropriate social skills and empathy, and small rewards for treatment adherence (Baroud et al., 2022). SUMMARY OF KEY POINTS ■ A one in six American youths is affected by a mental disorder that impairs their ability to function. ■ In addressing intellectual developmental disorder, the emphasis is on determining adaptive behaviors (e.g., conceptual skills, concepts, self-direction), social skills, and practical skills. With guidance and education, many children will no longer have a disability as adults.

■ Children with ASD benefit from structure and specific behavioral interventions. ■ ADHD is defined by the presence of inattention; impulsiveness; and in most cases, hyperactivity. As currently defined, ADHD is the most common dis order of childhood. This heterogeneous disorder affects male children more often than female children. Nursing interventions involve family and child edu cation and support. The family must partner with the school system to help the child receive the best educa tional experience. Effective treatment of ADHD often involves multiple approaches, including medication and parental education and support. ■ Tourette syndrome is a tic disorder characterized by motor and vocal tics. It is a frustrating disorder that requires patience and understanding. About half of the children with this disorder also have ADHD. ■ Separation anxiety is relatively common in school aged children. OCD becomes more common in ado lescents. Treatment of separation anxiety and OCD may include medication, behavioral therapy, or a com bination of these treatments. ■ Elimination disorders include encopresis and enuresis. Behavioral therapy approaches are the most effective treatment for these disorders. Medication may also be used. ■ Major depression in children is believed to be similar to major depression in adults. ■ Childhood schizophrenia is a rare disorder, so other diagnoses should be carefully considered. Nursing care is similar to care of children with ASD. DEVELOPING CLINICAL JUDGMENT 1. What are some approaches to obtaining assessment data about a child with a mental disorder? 2. When interviewing parents of a child with an intellectual developmental disorder, what questions might you ask? 3. Examine the differences and similarities between ASD with and without intellectual and language impairment. 4. Compare and contrast nursing approaches for a child with ADHD with those used for a child with ASD. How are they different? How are they similar? 5. Learning disabilities and communication disorders are more common in children with psychiatric disorders than in the general population. How might a learning disability or a communication disorder complicate a psychiatric illness in a school-aged child? 6. How would you answer these questions from a parent: “What causes ADHD? Is it my fault”?

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