Often bullies threatens or intimidates others

Often bullies, threatens or intimidates others, initiates fights, used a weapon to
threaten or harm, physically cruel to others and animals, has stolen, has forced
sexual activity, truancy or school drop out
▪ Often affects boys more than girls
▪ In girls = promiscuity, truancy, drug abuse, prostitution, runaways, high risk
behaviors, smoking, drinking
▪ May exhibit lack of remorse or guilt, lack of empathy
▪ Disturbed peer relationships, may have ODD in childhood, ADHD
▪ First seen in middle childhood to middle adolescence – before age 16 (after age
18 = antisocial PD) -- earlier onset predicts a worse prognosis and increased risk
for criminal behavior
o Risk factors
▪ Parental rejection and neglect
▪ Inconsistent child-rearing practices
▪ Harsh discipline
▪ Large family size
▪ Frequent changes of caregivers
▪ Parental criminality

▪ Sexual abuse
▪ Lack of supervision
▪ Early institutional living
▪ Delinquent peer group
▪ Exposure to violence in neighborhood
▪ Antisocial family traits
o Interventions
▪ Tx often in outpatient setting
▪ Protect from harm
▪ Increase patient ability to trust and use interpersonal skills
▪ Increase ability to control impulses, tolerate frustration, control mood
▪ Increase use of cognitive skills (memory, concentration, test reality, solve
problems)
▪ Expose to positive role models, behavior modification model
▪ Foster development of self esteem
▪ May need meds
▪ Provide support, education, and guidance for parents
▪ Family therapy, group therapy, behavior modification, play therapy, CBT,
psychodrama, art therapy
o Meds
▪ Treat underlying issue like depression, ADHD, ODD, etc
• Oppositional Defiant DO … signs and symptoms, nursing diagnoses, outcomes, interventions o
Oppositional Defiant Disorder = problems with self-control of emotions and behavior o
Oppositional = argumentative, resistant, don’t want to do what people tell them to do
o Do not get in trouble with the law
o Sx present at home or in multiple settings
o Sx occur during preschool years – often precedes conduct disorder but not necessarily o
DSM5 = Pattern of angry/irritable mood, argumentative/defiant behavior lasting at least 6
months plus four or more of the symptoms below
▪ Angry/irritable mood, loses temper, easily annoyed, resentful
▪ Argumentative/defiant behavior with authority figures, with adults, defies or
refuses to comply with requests from authority figures, with rules, blames
others for his/her mistakes or behavior
▪ Vindictiveness = has spiteful or vindictive (ie revenge seeking)

o
o
Nursing diagnoses
▪ Risk for school problems, impulse control problems, substance use, anxiety o
Interventions
▪ Psychosocial interventions = parent training, group therapy, and anger
management and cognitive-behavioral therapy
▪ Pharmacological treatment
• Depression, Bipolar and Schizophrenia in children … signs and symptoms, nursing diagnoses,
outcomes, interventions, meds
o Depression
▪ Symptoms like adults - sadness and loss of pleasure
• What differs is how these symptoms are displayed -- a very young child
may cry, a school-age child might withdraw, and a teenager may