Child and Adolescent Behavioral Health

A Resource for Advanced Practice Psychiatric and Primary Care Practitioners in Nursing

Edilma L. Yearwood, Geraldine S. Pearson, Jamesetta A. Newland, Edilma L. Yearwood, Geraldine S. Pearson, Jamesetta A. Newland

• Publisher: Wiley-Blackwell
• Year: 2021
• ISBN:
  9781119487562
• Edition: 2
• Topic: Medicine
• Subtopic: Nursing

Research has shown that a range of adult psychiatric disorders and mental health problems originate at an early age, yet the psychiatric symptoms of an increasing number of children and adolescents are going unrecognized and untreated—there are simply not enough child psychiatric providers to meet this steadily rising demand. It is vital that advanced practice registered nurses (APRNs) and primary care practitioners take active roles in assessing behavioral health presentations and work collaboratively with families and other healthcare professionals to ensure that all children and adolescents receive appropriate treatment.

Child and Adolescent Behavioral Health helps APRNs address the mental health needs of this vulnerable population, providing practical guidance on assessment guidelines, intervention and treatment strategies, indications for consultation, collaboration, referral, and more. Now in its second edition, this comprehensive and timely resource has been fully updated to include DSM-5 criteria and the latest guidance on assessing, diagnosing, and treating the most common behavioral health issuesfacing young people. New and expanded chapters cover topics including eating disorders, bullying and victimization, LGBTQ identity issues, and conducting research with high-risk children and adolescents. Edited and written by a team of accomplished child psychiatric and primary care practitioners, this authoritative volume:

• Provides state-of-the-art knowledge about specific psychiatric and behavioral health issues in multiple care settings
• Reviews the clinical manifestation and etiology of behavioral disorders, risk and management issues, and implications for practice, research, and education
• Offers approaches for interviewing children and adolescents, and strategies for integrating physical and psychiatric screening
• Discusses special topics such as legal and ethical issues, cultural influences, the needs of immigrant children, and child and adolescent mental health policy
• Features a new companion website containing clinical case studies to apply concepts from the chapters

Designed to specifically address the issues faced by APRNs, Child and Adolescent Behavioral Health is essential reading for nurse practitioners and clinical nurse specialists, particularly those working in family, pediatric, community health, psychiatric, and mental health settings. *Second Place in the Child Health Category, 2021 American Journal of Nursing Book of the Year Awards*

1
Child, Adolescent, and Family Development

Stephanie Wright¹ and Edilma L. Yearwood²

¹ George Washington University School of Nursing, Washington, DC, USA

² Georgetown University School of Nursing & Health Studies, Washington, DC, USA

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Objectives

After reading this chapter, advanced practice registered nurses will be able to:

1. Understand child and adolescent development within biopsychosocial and environmental contexts.
2. Identify characteristics over the developmental continuum that represent age‐appropriate social and emotional behaviors of typically developing children and youth.
3. Determine at‐risk behaviors in children and youth across the developmental span requiring referral for additional evaluation.
4. Describe behaviors manifested by children and youth with high secure self‐esteem, high insecure self‐esteem, and low self‐esteem.
5. Compare and contrast models of cognitive development and their application to practice.
6. Demonstrate an understanding of common characteristics of language (phonology, morphology, syntax, semantics, and pragmatics) and language development.
7. Identify normal patterns of family development.
8. Identify social determinants of health that impact normal child development.

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Introduction

Knowledge of the characteristics of normal development in typically developing infants, children, and youth is a necessary precursor for recognizing characteristics that are considered atypical for the developmental stage. This knowledge is essential for advanced practice psychiatric and primary care practitioners in nursing who screen and monitor for the early signs of developmental abnormalities, mental illness, or behavioral difficulties. These can be indicative of minor developmental issues or of serious diagnostic conditions such as autism spectrum disorder (ASD) that can be ameliorated, although not cured, with intensive early intervention services. Understanding developmental norms aids in early recognition of mental health disorders such as depression in children and youth (American Academy of Child and Adolescent Psychiatry 2015). To identify these, advanced practice registered nurses (APRNs) must have the knowledge of developmental norms applicable to the children and adolescents they treat.

Early assessment, case finding, and treatment of psychiatric disorders in a youngster may preserve the child's sense of self, competence, and relatedness to others and prevent more serious behavioral and relationship issues. The areas of development chosen for review in this chapter reflect the topics discussed throughout this textbook. Descriptions of early brain development and typical social, emotional, and cognitive development spanning childhood to emerging adulthood are presented. In addition, because child, adolescent, and family development are influenced by contextual and interactional factors, Bronfenbrenner's Bioecological Theory of Human Development is used to illustrate the dynamic nature of these interactions and how individuals and families are either propelled or impeded in their developmental trajectory by these factors. More recently, social scientists are examining the impact of social determinants of health (SDH) on overall wellbeing and vulnerability across multiple groups across the lifespan. SDH are external factors such as socio‐economic status, neighborhood conditions, health literacy, educational level attained, early childhood experiences, availability, and access to resources among other things. SDH can affect individuals and families where they live, work and or play. Finally, the family is on a developmental trajectory that can complement or conflict with the trajectory of the child or adolescent while influencing individual and or family outcomes. Therefore, family characteristics and dynamics are discussed here.

Prenatal Development

Child development begins at conception with a basic cell and genetic structure. As the understanding of genetics rapidly increases, the model of how an individual's genetics interacts with human development is changing. Going from a fixed model in which human experience takes place within an individual's genetic context, it begins to be clear that the interaction of genetics and experience is much more nuanced than this, and is transactional and bidirectional in nature (Bjorklund and Causey 2017). This interaction is dynamic, with genes being turned on and off, possibly by other genes or by environmental influences. This fluid and dynamic concept of genetic/environmental interaction is changing our view of the developmental issues and problems encountered as practitioners and, ultimately, in the way in which they are treated (Gottesman and Hanson 2005).

Brain Development

The foundation for understanding child and adolescent development begins with knowledge of early and progressive brain development and environmental, chemical, and biological factors that can interfere with normal brain growth. From conception to age 2, brain development, while prolific, is uneven. Early brain development is characterized by several processes, including birth of neurons, neuronal migration, neural pathway development, synaptogenesis, and pruning or shedding of unwanted parts. Brain development begins about 2 weeks after conception and continues into adulthood. While prenatal brain development is largely under genetic control, it is clear that there are early environmental influences here (nutrition, hormones, exposure to toxins). Once the early neural tube is formed, neural proliferation proceeds, followed by migration, then differentiation of cells. Many more cells are formed than are needed, so many cells also die off during this process. The development of synapses then proceeds and follows a similar pattern, with an overproduction of synaptic connections and a later pruning of these connections that proceeds into childhood and adolescence (Tierney and Nelson 2009). This ability to form and prune neuronal connections accounts in part for the great plasticity of young brains. Neuronal and synaptic plasticity in the developing brain is believed to be both adaptive and maladaptive. Adaptive plasticity heralds an ability to learn new skills, store and retrieve information, respond to environmental stimuli, repair damage, and maintain an intact memory. Maladaptive plasticity is implicated in neurological disorders, while ex...