meet or expect to meet in your own practice. As you read the scholarly papers posted in the forum, further issues related to vulnerable aggregates will emerge.
New mothers, perhaps more than any other aggregate, look to Registered Nurses for support and guidance throughout their pre- and post-natal experiences. Opportunities to promote mental health exist in childbirth education classes, inpatient care throughout the birthing process, and pre-school vaccination clinics. One notable example is the primary prevention strategy mentioned previously where television advertisements promoting entirely substance free pregnancies are hoped to deter the onset of Fetal Alcohol Syndrome (FAS).
According to the Pacific Post Partum Support Society (http://www.postpartum.org/), both in Canada and internationally, an estimated one out of every six women experiences troubling depression or anxiety after the birth or adoption of a child. This is referred to as postpartum depression and can be a tremendously stressful time for the family. Many factors contribute to a difficult postpartum adjustment or depression including sleep deprivation, financial stress, grief over an unexpectedly difficult birth, a traumatic family history, and the high expectations of the mother and the society in which she lives. Instruments such as the Edinburgh Postnatal Depression Scale can help nurses identify potential problems and facilitate help through prompt referral and follow up.
Children and Adolescents
Knowing the differences between normal developmental milestones and psychopathology are essential when helping children and their parents. For example, repeated incidents of behaviours such as intentionally setting fires or maliciously hurting animals or other children are NOT normal. Research suggests that children who experience major losses, such as death or divorce, are at risk for the development of psychopathology (Boyd, 2008). Similarly, children whose parents engage in unhealthy lifestyles are also at risk. Issues of attachment with parents or significant others often emerge with younger children. Issues of seeking identity and independence through high risk behaviours such as drug use, unprotected sex, and delinquent behaviours often emerge with adolescents. Adolescents are considered an at risk population for suicide. Telephone hot lines are valuable resources for children and adolescents.
Recent advances in the psychiatric field, many of which are controversial, have created diagnostic “labels” for behaviours previously often considered simply a “phase” or “just part of growing up.” Standardized data collection instruments that involve parents, teachers, health professionals and the children themselves can assist with diagnosis and differentiating patterns of aberrant behaviour from isolated incidents of mischief.
DSM IV classification distinguishes among childhood disorders through categories such as developmental, externalizing, internalizing, and “other” behaviour. Developmental categories include Mental Retardation (below-average intellectual functioning as evidenced by an IQ score under 70) and Pervasive Developmental Disorders (PDD) including communication and learning disabilities. Autism, one common PDD, is a long-term disability where individuals seem detached and experience profound difficulty engaging and interacting with others. Children with autism often engage in repetitive behaviours such as incessant head banging.
Externalizing categories include the disruptive behaviour disorders: Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder and Conduct Disorder. Attention Deficit Hyperactivity Disorder (ADHD) is defined by the presence of inattention, impulsiveness and frequently, hyperactivity. Today, ADHD is a common disorder of children and adolescents and affects more boys than girls. Treatment approaches include combinations of medication (usually stimulants such as methylphenidate – Ritalin), parent/teacher training, and child behaviour programs. Primary features of Oppositional Defiant Disorder include persistent disobedience, argumentativeness, and tantrums. Conduct Disorder is characterized by lying, truancy, stealing, and fighting.
Internalizing categories include Depression and Anxiety disorders. Major Depressive illness in children presents in parallel ways as Major Depression does in adults and is often treated with anti depressant medication. However, the use of psychotropic medication of any kind with children and adolescents, whose bodies and minds are continuing to develop, remains an issue that requires further research. Separation Anxiety and Obsessive Compulsive Disorders may emerge in children as well.
Other disorders of children and adolescents include encopresis (repeated passage of feces into inappropriate places), enuresis (repeated voiding of urine into inappropriate places), Tourette’s (vocal or motor tics) and in rare cases, childhood schizophrenia.
A variety of treatment approaches exist and children and their families are generally best advised to consider a combination of treatment possibilities. Family therapy, nutritional counseling, play therapy, alternative medicine, bibliotherapy and psychopharmacology may all offer help.
Once again, knowing the differences between normal developmental transitions expected within the aging process and psychopathology is essential when helping our elders. Losses associated with declining physical abilities, the death of spouse and friends, and a need for assisted living will evoke sadness. Also, preparing for death through actions such as writing a will, giving away prized possessions, and discussing the experience of death and afterlife beliefs are all anticipated.
However, clinical depressive and anxiety disorders can be overlooked with this population. Assessment for suicidal ideation and persistent feelings of fear and dread are often indicated. As we have emphasized throughout this course, careful observation and documentation translated into relevant assessment instruments can greatly assist clients. Extensive literature from nursing and other disciplines is available and you are encouraged to remain informed about mental health issues specific to vulnerable aggregates of elderly that you encounter in your own professional practice.
Survivors of Violence
In the 1800′s, it was the Society for the Prevention of Cruelty to Animals (SPCA) who first interceded on behalf of a child being beaten. Since then, throughout the world, agencies and organizations have been created to prevent and eliminate violence. However, individuals and groups continue to use violent means to impose power and control over others. Violence can include physical, emotional, and sexual harm and may be present in any area of life. Examples include spouse, child and elder abuse in families, sexual abuse including rape in interpersonal relationships, bullying behaviour in schools and workplaces, and acts of terrorism and torture perpetrated by one ethnic group on another