494 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS
continued from page 493This approach, called shaping,is a behavioral
procedure in which successive approximations of
a desired behavior are positively reinforced. It al-
lows rewards to occur as the client gradually mas-
ters the actual expectation.Client independence is promoted as staff partici-
pation is decreased.Sequencing questions provide a structure for dis-
cussions to increase logical thought and decrease
tangentiality.Successful interventions can be instituted by the
client’s family or caregivers by using this process.
This will promote consistency and enhance the
client’s chances for success.It is important for parents or caregivers to engage
in techniques that will maintain their loving
relationship with the child while promoting or at
least not interfering with therapeutic goals.
Children need to have a sense of being lovable to
their significant others that is not crucial to the
nurse–client therapeutic relationship.Give the client positive feedback for performing
behaviors that come close to task achievement.Gradually decrease reminders.Assist the client to verbalize by asking sequenc-
ing questions to keep on the topic (“Then what
happens?” and “What happens next?”).*Teach the client’s family or caregivers to use the
same procedures for the client’s tasks and inter-
actions at home.*Explain and demonstrate “positive parenting”
techniques to family or caregivers such as time-in
for good behavior; i.e., being vigilant in identifying
the child’s first bid for attention and responding
positively to that behavior; special time,i.e., guar-
anteed time a parent or surrogate spends daily
with the child with no interruptions and no dis-
cussion of problem-related topics; ignoring minor
transgressionsby immediate withdrawal of eye
contact or physical contact and cessation of discus-
sion with the child to avoid secondary gains.10 years of age. These adolescents are less likely to
be aggressive, and they have more normal peer re-
lationships. They are less likely to have persistent
conduct disorder or antisocial personality disorder
as adults (APA, 2000).
Conduct disorders can be classified as mild, mod-
erate, or severe (APA, 2000):- Mild:The person has some conduct problems
that cause relatively minor harm to others.
Examples include lying, truancy, and staying
out late without permission. - Moderate:The number of conduct problems
increases as does the amount of harm to
others. Examples include vandalism and
theft.
behaviors. It occurs three times more often in boys
than in girls. As many as 30% to 50% of these chil-
dren are diagnosed with antisocial personality dis-
order as adults.
Onset and Clinical Course
Two subtypes of conduct disorder are based on age of
onset. The childhood-onset type involves symptoms
before 10 years of age including physical aggression
toward others and disturbed peer relationships.
These children are more likely to have persistent
conduct disorder and to develop antisocial personal-
ity disorder as adults. Adolescent-onset type is de-
fined by no behaviors of conduct disorder until after
Adapted from Schultz, J. M. & Videbeck, S. L. (2002). Lippincott’s Manual of Psychiatric Nursing Care Plans (6th ed.). Philadelphia:
Lippincott Williams & Wilkins.