Comprehensive Nursing Management:
Childhood & Adolescent Behavioral & Emotional Disorders
A detailed guide for student nurses and professionals
• Organized • Memory Aids
Introduction
Childhood and adolescence are transformative periods of emotional, cognitive, and social development. Behavioral and emotional disorders manifesting during this time can significantly impact growth, academic progress, family dynamics, and society. Early identification and intervention, coupled with evidence-based nursing care, improve prognosis and quality of life.
This comprehensive reference is designed for nursing students and professionals seeking an in-depth, practical approach to managing childhood and adolescent behavioral & emotional disorders, including Intellectual Disability (ID), Autism Spectrum Disorder (ASD), Attention-Deficit Hyperactivity Disorder (ADHD), Eating Disorders, and Learning Disorders.
Overview: Childhood Behavioral & Emotional Disorders
Definition and Scope
Behavioral and emotional disorders in childhood and adolescence are a diverse group of mental health conditions presenting as abnormal thoughts, feelings, or actions compared to age-appropriate norms. These disorders can have biological, psychological, or social bases, and frequently overlap.
Memory aid: Think “BEACHL” for Behavioral/&Emotional disorders: C (Conduct problems), A (ADHD/Autism), H (Hyperactivity), L (Learning disorders), E (Eating disorders), I (Intellectual disability).
General Classification
- Neurodevelopmental Disorders (ID, ASD, ADHD, LD)
- Behavioral Disorders (Conduct, ODD)
- Emotional Disorders (Depression, Anxiety, Eating Disorders)
Nursing Considerations
- Early detection and tailored interventions are paramount.
- Family-centered, multidisciplinary approaches yield better outcomes.
- Stigma reduction and advocacy are integral to holistic care.
Intellectual Disability (ID) / Intellectual Developmental Disorder (IDD)
Prevalence & Incidence
- Global prevalence: 1–3% of the population1.
- More common in males; ratio ≈ 1.5:1.
- Higher rates in low-resource settings.
Classification
By severity (based on IQ):
Mild (IQ 50–69, ~85%),
Moderate (IQ 35–49, 10%),
Severe (IQ 20–34, 3–4%),
Profound (IQ <20, 1–2%).
Mild (IQ 50–69, ~85%),
Moderate (IQ 35–49, 10%),
Severe (IQ 20–34, 3–4%),
Profound (IQ <20, 1–2%).
Etiology & Psychodynamics
| Type | Example Causes |
|---|---|
| Genetic | Down syndrome, Fragile X, PKU |
| Prenatal | TORCH infections, alcohol exposure |
| Perinatal | Birth asphyxia, prematurity |
| Postnatal | Meningitis, trauma, severe malnutrition |
Memory aid: “GPPP” — Genetic, Prenatal, Perinatal, Postnatal.
Characteristics & Diagnostic Criteria
- Deficits in intellectual functioning (reasoning, learning, problem-solving)
- Deficits in adaptive functioning (personal independence, social responsibility)
- Onset during developmental period (<18 years)
Nursing Assessment
- History: Prenatal/perinatal/postnatal insults, developmental delays
- Physical exam: Dysmorphic features, growth parameters
- Mental status: Communication, social skills, attention span
- IQ Assessment: Standardized tests (e.g., WISC, Stanford-Binet)
Treatment Modalities
- Pharmacologic: To manage comorbidities (seizures, ADHD, etc.)
- Non-pharmacologic: Special education, speech/occupational/physical therapy, behavior interventions
Key Nursing Interventions:
- Promote optimal independence in daily living
- Educate and support families
- Protect from injury
- Monitor for comorbidities
- Advocate for special needs resources
Rehabilitation & Home Care
- Family and community integration
- Lifelong learning and vocational skills
- Referral to support groups
Autism Spectrum Disorder (ASD)
Prevalence & Incidence
- Global prevalence: ~1–2%, increasing trend2
- Boys affected 4x more than girls
- Usually diagnosed by age 3–4
Classification
- DSM-5: Single diagnosis encompassing Autism, Asperger’s, and PDD-NOS
- Severity graded by required support (Level 1–3)
Etiology & Psychodynamics
| Factors | Description |
|---|---|
| Genetic | Complex heritability; several genes implicated |
| Environmental | Advanced parental age, prenatal exposure to drugs, perinatal insults |
| Biological | Abnormal brain structure/connections |
Memory aid: “GEB” — Genetic, Environmental, Biological.
Characteristics & Diagnostic Criteria
- Deficits in social-emotional reciprocity (difficulty with social interaction)
Mnemonic: “ADS”: Atypical socialization, Delimited interests, Stereotypy - Deficits in verbal/non-verbal communication
- Restricted, repetitive patterns of behavior/interests (e.g., hand-flapping, routines)
- Symptoms present early and impair functioning
Nursing Assessment
- History: Regression or delay in speech/social milestones, family hx
- Physical: Minor anomalies, coordination
- MSE: Eye contact, emotional reciprocity, unusual play
- Tools: ADOS, CARS, M-CHAT
Treatment Modalities
- Behavioral: Applied Behavior Analysis (ABA), social skills training
- Educational: Individualized Education Programs (IEP)
- Pharmacologic: Treat comorbid symptoms (irritability, aggression, ADHD)
- Speech/OT/PT therapies
Key Nursing Interventions:
- Structured, predictable routines
- Reduce sensory overload
- Use clear, simple communication
- Encourage positive social interactions
- Family education and support
Rehabilitation & Home Care
- Parental guidance for home-based behavior modification
- Community resources and respite care
- Support for transition to adulthood/vocational training
Attention Deficit Hyperactivity Disorder (ADHD)
Prevalence & Incidence
- Global prevalence: ~5% of children3
- Boys : girls ≈ 2:1 – 3:1
- Onset before age 12; persists into adulthood in ≥50% cases
Classification
- Predominantly inattentive
- Predominantly hyperactive-impulsive
- Combined presentation
Etiology & Psychodynamics
| Type | Examples |
|---|---|
| Genetic | Strong heritability (≈75%, Dopaminergic pathway genes) |
| Biological | Frontostriatal dysfunction, neurotransmitter imbalances |
| Environmental | Prenatal exposure (alcohol, tobacco), low birth weight, psychosocial adversity |
Memory aid: “GBE” — Genetic, Biological, Environmental.
Characteristics & Diagnostic Criteria
- Persistent pattern >6 months of:
- Inattention (easily distracted, forgetful, unable to finish tasks)
- Hyperactivity/impulsivity (fidgets, interrupts, difficulty waiting)
- Symptoms in more than one setting. Start before age 12
Mnemonic: “SHIMPS” (Symptoms Hyperactive, Inattentive, Multiple Places, Six months)
Nursing Assessment
- History: Perinatal/psychiatric history, family functioning
- Physical/Neuro: Rule out hearing/vision impairment
- MSE: Attention span, impulse control
- Rating scales: Vanderbilt, Conners, SNAP-IV
Treatment Modalities
- Pharmacologic: Stimulants (methylphenidate, amphetamines), non-stimulants (atomoxetine, guanfacine)
- Behavioral: Parent training, contingency management, classroom interventions
- Environmental modifications: Structure, task breakdown, visual cues
Key Nursing Interventions:
- Provide clear, concise instructions
- Reinforce positive behaviors consistently
- Use charts/timers for tasks
- Monitor growth and medication side effects
- Encourage regular routines and physical activity
Rehabilitation & Home Care
- Support parents in behavior management skills
- Advocate for school accommodations (IEP/504 plans)
- Community programs for social skills/vocational training
Eating Disorders
Prevalence & Incidence
- Peak onset: adolescence; typically 12–25 years4
- Lifetime prevalence: ~2–4% (Anorexia, Bulimia, BED combined)
- Female:male ratio up to 10:1 (but rising among males)
- Most common: Binge Eating Disorder (BED); most lethal: Anorexia Nervosa
Classification
- Anorexia Nervosa (AN): restricting, binge-purging types
- Bulimia Nervosa (BN): binge eating + compensatory behaviors
- Binge Eating Disorder (BED): periodic bingeing without compensation
- Others: ARFID, Pica, Rumination
Mnemonic: “A BB RPA” — Anorexia, Bulimia, Binge, Rumination, Pica, ARFID.
Etiology & Psychodynamics
- Genetic predisposition (twins studies; 50–80% heritability for AN)
- Biological: serotonin/dopamine alterations, pubertal hormonal changes
- Psychological: perfectionism, low self-esteem, control issues
- Sociocultural: media pressure, trauma, family dysfunction
Characteristics & Diagnostic Criteria
| Disorder | Key Features |
|---|---|
| Anorexia Nervosa | Restriction of intake, fear of weight gain, distorted body image, BMI < 18.5 |
| Bulimia Nervosa | Recurrent binge eating followed by compensatory behaviors (vomiting, laxatives, excessive exercise) |
| Binge Eating Disorder | Recurrent binge-eating, no regular compensatory behaviors, marked distress |
Nursing Assessment
- History: Diet/weight hx, exercise patterns, family attitudes to food/appearance, traumatic experiences
- Physical: Weight, vital signs, skin/hair changes, amenorrhea, dental/gastrointestinal issues
- MSE: Cognitions about food/weight, self-harm behaviors, suicidal ideation
- Labs: Electrolytes, CBC, ECG
Avoid memory trap: “FEED” — Food restriction, Electrolyte disturbances, Emotional distress, Dental erosion.
Treatment Modalities
- Pharmacologic: SSRIs (fluoxetine for BN), antipsychotics (olanzapine for AN), treat comorbidities
- Psychotherapy: Cognitive-behavioral therapy (CBT), Family-based therapy (FBT, Maudsley method)
- Nutritional rehabilitation: Meal planning, dietician, monitoring for refeeding syndrome
Key Nursing Interventions:
- Monitor fluid/electrolyte balance and vital signs continuously
- Observe for post-meal behaviors
- Establish structured eating schedules
- Avoid power struggles; use motivational interviewing
- Educate about complications and healthy body image
Rehabilitation & Home Care
- Involve family in therapy
- Monitor for medical/psychiatric relapse
- Refer to support groups and school counselors
Learning Disorders (LD)
Prevalence & Incidence
- 5–15% of school-aged children globally5
- Dyslexia most common (>80% of LD cases)
- Underdiagnosed in non-English speaking and low-income communities
Classification
- Dyslexia: Reading/writing impairment
- Dyscalculia: Mathematical deficits
- Dysgraphia: Handwriting and written expression deficits
Mnemonic: “3 Ds: Dyslexia, Dyscalculia, Dysgraphia”
Etiology & Psychodynamics
- Genetic: strong familial clustering, >50% heritability
- Neurobiological: Abnormal brain processing regions, especially left hemisphere
- Environmental: Prematurity, brain injury, psychosocial adversity
Memory aid: “GEN” — Genetic, Environmental, Neurobiological
Characteristics & Diagnostic Criteria
- Persistent difficulties in reading/writing, math, or expressing thoughts in writing
- Skill level substantially below what is expected for age/class level
- Not due to intellectual disability, sensory deficit, or lack of instruction
Nursing Assessment
- History: Onset and progression of difficulties, family history
- Physical: Rule out vision/hearing impairment, neurological assessment
- Psych/Educational: Psychoeducational assessment, standardized achievement tests
Treatment Modalities
- Educational interventions: Multisensory instruction, remediation programs (Orton–Gillingham)
- Assistive technology: Audio books, speech-to-text software
- Classroom strategies: Extended time, differentiated instruction
- Psychological support for low self-esteem
Key Nursing Interventions:
- Screen early and refer for assessment
- Work with teachers and specialists for IEPs
- Support self-esteem and social skills
- Educate families on advocacy
Rehabilitation & Home Care
- Promote reading at home, organize tutoring
- Engage families in educational planning
- Connect to community literacy programs
General Nursing Management Strategies for Childhood Disorders
Therapeutic Milieu & Environment
- Establish safe, structured, and predictable routines
- Reduce environmental triggers (noise, visual overload)
Therapeutic Communication
- Use developmentally appropriate language
- Active listening and empathy
- Encourage expression of feelings in safe ways
Family & School Collaboration
- Collaborate on Individualized Education Plans (IEPs)
- Support parental education and involvement
Medication Administration
- Monitor for side effects, adherence, and efficacy
- Educate family about doses, timing, and possible reactions
Behavioral Interventions
- Reinforce positive behaviors
- Set clear, consistent limits and expectations
Crisis Prevention & Management
- Identify early signs of decompensation
- Establish de-escalation plans and emergency contacts
Mnemonic: “SAFE CARE”:
Structured routines, Appropriate communication, Family involvement, Education, Collaboration, Administration (meds), Reinforcement, Emergency planning
Structured routines, Appropriate communication, Family involvement, Education, Collaboration, Administration (meds), Reinforcement, Emergency planning
Follow-up, Home Care, and Rehabilitation
Principles
- Continuity of care across transitions (child/adolescent/adult services)
- Family-centered, strengths-based approach
- Community integration
Key Strategies
- Schedule regular follow-ups to monitor progress and identify relapses
- Coordinate with schools, therapists, pediatricians
- Home-based training for ADLs, communication, and coping
Resources/Referrals
- Special education and vocational training programs
- Parent support and counseling groups
- Social services for financial and respite care assistance
Mnemonic: “CARE” — Continuity, Advocacy, Rehabilitation, Education.
Prevalence of Disorders Among Children (Demo Chart)
References & Further Reading
- Stevenson J, Meares R, et al. “Intellectual Disability.” Lancet, 2019.
- Maenner MJ, Shaw KA, et al. “Prevalence of Autism Spectrum Disorder.” MMWR Surveill Summ., 2020.
- Polanczyk G, Rohde LA, et al. “ADHD worldwide prevalence.” Am J Psychiatry, 2014.
- Lock J, La Via MC. “Practice parameter for the assessment and treatment of children and adolescents with eating disorders.” J Am Acad Child Adolesc Psychiatry, 2015.
- S. Shaywitz. “Dyslexia.” New England Journal of Medicine, 1998.
- DSM-5-TR (American Psychiatric Association). Neurodevelopmental and Other Disorders.
- World Health Organization (WHO). “ICD-11 Mental, behavioural or neurodevelopmental disorders.”
- National Institute of Mental Health. https://www.nimh.nih.gov/
Last updated: June 2024