Psychiatric Mental Health Nursing by Videbeck

20 CHILD ANDADOLESCENTDISORDERS 503

OPPOSITIONAL DEFIANT DISORDER

Oppositional defiant disorder consists of an enduring
pattern of uncooperative, defiant, and hostile behav-
ior toward authority figures without major antisocial
violations. A certain level of oppositional behavior
is common in children and adolescents; indeed, it
is almost expected at some phases such as 2 to 3 years
of age and in early adolescence. Table 20-2 contrasts
acceptable characteristics with abnormal behavior in
adolescents. Oppositional defiant disorder is diag-
nosed only when behaviors are more frequent and in-
tense than in unaffected peers and cause dysfunction
in social, academic, or work situations. This disorder
is diagnosed in about 5% of the population and occurs
equally among male and female adolescents. Most
authorities believe that genes, temperament, and ad-
verse social conditions interact to create oppositional
defiant disorder. Twenty-five percent of people with
this disorder develop conduct disorder; 10% are diag-
nosed with antisocial personality disorder as adults
(Steiner, 2000). Treatment approaches are similar to
those used for conduct disorder.

◗ FEEDING ANDEATINGDISORDERS OF

INFANCY ANDEARLYCHILDHOOD

The disorders of feeding and eating included in this
category are persistent in nature and are not ex-
plained by underlying medical conditions. They in-
clude pica, rumination disorder, and feeding disorder.

PICA

Picais persistent ingestion of nonnutritive sub-
stances such as paint, hair, cloth, leaves, sand, clay,
or soil. Pica is commonly seen in children with men-
tal retardation; it occasionally occurs in pregnant
women. It comes to the clinician’s attention only if a

medical complication develops, such as a bowel ob-

struction or infection, or if a toxic condition develops,

such as lead poisoning. In most instances, the be-

havior lasts for several months and then remits.

RUMINATION DISORDER

Rumination disorderis the repeated regurgitation

and rechewing of food. The child brings partially di-

gested food up into the mouth and usually rechews

and reswallows the food. The regurgitation does not

involve nausea, vomiting, or any medical condition

(APA, 2000). This disorder is relatively uncommon

and occurs more often in boys than in girls; it results

in malnutrition, weight loss, and even death in about

25% of affected infants. In infants, the disorder fre-

quently remits spontaneously but it may continue in

severe cases.

FEEDING DISORDER

Feeding disorder of infancy or early childhood is

characterized by persistent failure to eat adequately,

which results in significant weight loss or failure to

gain weight. Feeding disorder is equally common in

boys and in girls and occurs most often during the

first year of life. Estimates are that 5% of all pedi-

atric hospital admissions are for failure to gain weight

and up to 50% of those admissions reflect a feeding

disorder with no predisposing medical condition. In

severe cases malnutrition and death can result, but

most children have improved growth after some time

(APA, 2000).

◗ TICDISORDERS

A ticis a sudden, rapid, recurrent, nonrhythmic,

stereotyped motor movement or vocalization (APA,

2000). Tics can be suppressed but not indefinitely.

Table 20-2

ACCEPTABLECHARACTERISTICS ANDABNORMALBEHAVIOR INADOLESCENCE

Acceptable Abnormal

Occasional psychosomatic complaints Fears, anxiety, and guilt about sex, health, education

Inconsistent and unpredictable behavior Defiant, negative, or depressed behavior

Eagerness for peer approval Frequent hypochondriacal complaints

Competitive in play Learning irregular or deficient

Erratic work-leisure patterns Poor personal relationships with peers

Critical of self and others Inability to postpone gratification

Highly ambivalent toward parents Unwillingness to assume greater autonomy

Anxiety about lost parental nurturing Acts of delinquency, ritualism, obsessions

Verbal aggression to parents Sexual aberrations

Strong moral and ethical perceptions Inability to work or socialize

Adapted from Cotton, N. S. (2000). Normal adolescence. In B. J. Sadoch & V. A. Sadoch (Eds.). Comprehen-
sive textbook of psychiatry(7th ed., pp. 2550–2557). Philadelphia: Lippincott Williams & Wilkins.