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Week 7: Learning and Motor Disorders in Childhood

“I had a substitute teacher today, so it was not a good day. She thought I was goofing off, but I could not help myself. As much as I tried to hold back, knowing she would freak out, I felt like a volcano. I erupted with a sound, kinda like a bullfrog that lasted for almost 10 minutes. She kept telling me to quiet down, but I could not help myself. Then the physical stretching and flexing of my neck started. She was really mad. Finally, my friend told her about me. It was embarrassing.”

Samuel, age 9

Learning disorders represent a diagnostic challenge in that many of the features of learning disorders overlap with ADHD. Appropriate diagnosis is essential to proper treatment. Motor disorders can be a source of considerable distress for both the child and their parents. Appropriate diagnosis is required in order to initiate the most appropriate treatment to minimize the impact of these conditions on the child.

This week, you work with your group again to develop a Parent Guide for an assigned learning or motor disorder. For your practicum, you examine the practice of voluntary and involuntary commitment of children and adolescents with mental health disorders.

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

American Nurses Association. (2014).
Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). Washington, DC: Author.

• Standard 9 “Evidence-Based Practice and Research” (pages 71-72)

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014).
Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

• Chapter 4, “Theories of Personality and Psychopathology” (pp. 151–191)
• Chapter 31, “Child Psychiatry” (pp. 1181–1205)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

• “Neurodevelopmental Disorders”
• “Specific Learning Disorder”
• “Motor Disorders”

Murphy, T. K., Lewin, A. B., Storch, E. A., Stock, S. (2013). Practice parameter for the assessment and treatment of children and adolescents with tic disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 52(12), 1341–1359. Retrieved from
http://www.jaacap.com/article/S0890-8567(13)00695-…

McGavey, E. L., Leon-Verdin, M., Wancheck, T. N., & Bonnie, R. J. (2013). Decisions to initiate involuntary commitment: The role of intensive community services and other factors. Psychiatric Services, 64(2), 120-126.

Kaltiala-Heino, R. (2010). Involuntary commitment and detainment in adolescent psychiatric inpatient care. Social Psychiatry Epidemiology, 45(8), 785-793. doi: 10.1007/s00127-009-0116-3.

Lindsey, M. A., Joe, S., Muroff, J., & Ford, B. E. (2010). Social and clinical factors associated with psychiatric emergency service use and civil commitment among African-American youth. General Hospital Psychiatry, 32(3), 300-309. doi:10.1016/j.genhosppsych.2010.01.007

Review the following medications:

Note: Many of these medications are FDA approved for adults only. Some are FDA approved for disorders in children and adolescents. Many are used “off label” for the disorders examined in this week. As you read the Stahl drug monographs, focus your attention on FDA approvals for children/adolescents (including “ages” for which the medication is approved, if applicable) and further note which drugs are “off label.”

Optional Resources

Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015).
Rutter’s child and adolescent psychiatry (6th ed.). Hoboken, NJ: Wiley Blackwell.

• Chapter 47, “Children With Specific Sensory Impairments” (pp. 612–622)

Assignment 1: Practicum Journal: Voluntary and Involuntary Commitment

PMHNPs may find themselves working in a wide variety of settings—each having their own unique challenges and inherent legal issues. For instance, what do you do in your state of practice when you are providing a therapy/treatment session and a client reports active suicidal ideation? What do you do if you are covering inpatient psychiatric consults and are called to see a patient in the ICU who overdosed on prescription medication requiring intubation? What do you do if you are a PMHNP on an inpatient unit and a client who admitted themselves on a voluntary basis suddenly states that they have decided to sign themselves out of the hospital so that they can go home to kill themselves? These are just some of the legal questions that PMHNPs must know the answers to specific to their state of licensure/practice.

In this Assignment, you investigate your state’s laws concerning voluntary and involuntary commitment. You also analyze a case to determine if the client is eligible for involuntary commitment.

Scenario for Week 7 Case:

You are a PMHNP working in a large intercity hospital. You receive a call from the answering service informing you that a “stat” consult has been ordered by one of the hospitalists in the ICU. Upon arriving in the ICU, you learn that your consult is a 14 year old male who overdosed on approximately 50 Benadryl (diphenhydramine hydrochloride) tablets in an apparent suicide attempt. At the scene, a suicide note was found indicating that he wanted to die because his girlfriend’s parents felt that their daughter was too young to be “dating.” The client stated in the suicide note that he could not “live without her” and decided to take his own life. Although he has been medically stabilized and admitted to the ICU, he has been refusing to talk with the doctors or nurses. The hospital staff was finally able to get in touch with the clients parents (using contact information retrieved from the 14 year old’s cell phone). Unbeknown to the hospital staff, the parents are divorced, and both showed up at the hospital at approximately the same time, each offering their own perspectives on what ought to be done. The client’s father is demanding that the client be hospitalized because of the suicide, but his mother points out that he does not have “physical custody” of the child. The client’s mother demands that the client be discharged to home with her stating that her son’s actions were nothing more than a “stunt” and “an attempt at manipulating the situation that he didn’t like.” The client’s mother then becomes “nasty” and informs you that she works as a member of the clerical staff for the state board of nursing, and if you fail to discharge her child “right now” she will make you “sorry.” How would you proceed?

Learning Objectives

Students will:

• Evaluate clients for voluntary commitment
• Evaluate clients for involuntary commitment based on state laws
• Recommend actions for supporting parents of clients not eligible for involuntary commitment
• Recommend actions for treating clients not eligible for involuntary commitment

To Prepare for this Practicum:

• Review the Learning Resources concerning voluntary and involuntary commitment.
• Read the Week 7 Scenario in your Learning Resources.
• Research your state’s laws concerning voluntary and involuntary commitment.

The Assignment (2pages):

• Based on the scenario, would you recommend that the client be voluntarily committed? Why or why not?
• Based on the laws in your state, would the client be eligible for involuntary commitment? Explain why or why not.
• Did understanding the state laws confirm or challenge your initial recommendation regarding involuntarily committing the client? Explain.
• If the client were not eligible for involuntary commitment, explain what actions you may be able to take to support the parents for or against voluntary commitment.
• If the client were not eligible for involuntary commitment, explain what initial actions you may be able to take to begin treating the client.