Problems Encountered amoong Children and Adolescents

Our Lady of Fatima University

College of Nursing

NCM101 – Human Behavior

Common Problems Encountered Among Children & Adolescents

A. Death & Grieving

(lectures ask the students about their point of view about death)

Death is defined as cessation of bodily functions.

Grief is subjective individual feeling perpetuated by death or loss of loved one.

Because different age group have different attitude or point of view regarding death.

Under 5 y/o view death as it is a separation similar to sleep. Because preschoolers, according to Jean Piaget’s cognitive theory, they have animistic thinking, meaning that even inanimate objects have feeling and are alive. Like the way how they hold their dolls. They cuddle it and feed the like that they were really alive. If these children view objects as alive, what more they view a dead individual. They see it like they were only asleep.

5-10 y/o children have a concrete thinking according to Piaget. These children have a developing sense of inevitable human mortality. They already have fears that their parents will die and that they will be abandoned. They view death that it could only happen to an adult, and death will not happened to their age group.

9 or 10 y/o children can now conceptualize death as something that can happen to a child as to a parent. They can now understand that even their age group can die.

In puberty age, like our definition of death, they can now conceptualize death as universal, irreversible, and inevitable, as do adults definition of death.

Classification of Death

Timely vs. Untimely Death

In timely death, death occur among normal aging process in which the body cells ceases to function because of wear and tear. During this time death is readily acceptable by the person who is dying and the family that will be left behind. Examples of these are: death of an old man because of the complications of his lung disease, death of an adult lady because of the complications of her cancer.

Untimely death may refer to the following: 1) death of a young person 2) sudden or unexpected death 3) catastrophic death or an accident and utter meaningless death.

Intentional vs. Sub-intentional vs. Unintentional Death

Intentional death is termination of ones own life purposely. Example is death by committing suicide.

Sub-intentional death is killing oneself slowly or so called “killing me softly”. Examples are alcoholism that may eventually lead to death due to liver disease. Smoking that may eventually lead to death due to lung diseases. Substance abuse/dependent and sex workers that may expose them to dreaded infection like AIDS. Coal miners that are exposed to toxic substances such as asbestos and other chemicals.

Unintentional death is death due to trauma and diseases. Death occur because of accident and diseases without intention.

Reaction to Impending Death according to Kubler-Ross

The first reaction to death is that person will experience shock. Then after that, denial, that person will deny the fact that he is dying by stating “No! Not me!” Anger will set in next and ask himself “Why me?” this person will feel frustrated, irritable and angry. Angry to God, family, to doctors, nurses and even to self. During this stage patient are very difficult to treat. Most common defense mechanism used by this person is displacement. After anger is bargaining. During this stage, the person will attempt to negotiate with physicians, friends or even with God in return for a cure. They will fulfill one or many promises. They are very charitable, attend church to call all the saints that could help him. They are very compliant, non-questioning and cheerful thinking that their doctor will make them better. The next stage is the stage of depression. This time the person is withdrawn. There is psychomotor retardation, sleep disturbances, and hopeless. They are prone for suicidal tendencies. Then the last stage is the stage of acceptance. Now the patient realize that his death is inevitable.

B. Children & Adolescent’s Reaction to Separation and Divorce

Immediately after divorce, an increase in behavioral and emotional disorders appears in all age group.

3 – 6 years – children do not understand what is happening, and those who do understand often assume that they are responsible for the divorce in some way

7 – 12 years – school performance generally declines

Older children especially adolescents – comprehend the situation and believe that they could prevented the divorce if they could have intervened in some way

C. Sibling Relationships

· children are fighting constantly in all families

· remember that children gets frustrated or angry with a sibling and unlike adults they don’t have the self-control or the wisdom to handle frustration as adults have learned

· parent’s role is to teach self-control and give them wisdom

· if you need to interrupt argument, don’t take sides

· as a last resort, tell them if they can’t get along then they’ll be separated and won’t have the chance to fight with one or the other sibling.

Birth Order

First Born – highly valued than are subsequent children, particularly if the first born is male. They are achievement oriented and achieves the most. They are the most authoritariant.

Second and third children (middle child) – advantage of their parents’ previous experience. They receives least attention in home and may develop strong peer relationships to compensate.

Youngest – receive too much attention and be spoiled

Only Child – never dethroned by another sibling but experiences shock when he learns that he cannot remain the center of attention

D. Physical Fitness

According to Alfred Adler children battle for organ or body superiority. They are competitive but if gets frustrated they bully weaker and smaller children to achieve again superiority.

E. Adolescent risk-taking behavior

Common reasons for the risk-taking behavior of adolescents

curiosity
peer pressure
belief that they are indestructible
form of rebellion
impulsivity

Result of risk-taking behavior of adolescents:

excellence in sports – positive
social delinquency
teenage pregnancy
accidents
killing\death

Risk Factors for Childhood Psychopathology

A. Poverty and homelessness

Common issues that homeless children face:

a. diminish sense of place and loss of contact with familiar things

b. lessen sense of identity

c. weakened sense of security and trust to parents

d. change in behavior in response to stress

1. internalizing behavior

a. depression

b. anxiety

2. externalizing behavior

a. hostility

b. anti-social behavior

c. aggression

3. learning disabilities

Lower test score, lesser safety, high drop-out rates

Poverty and homelessness influence the child’s development. By limiting the child’s material and social access to stimulation, it impairs both learning and necessary nurturing. It influences insecurity of the family through stress about finances and social support.

B. Child abuse and neglect

It involves emotional or physical abuse or neglect, as well as sexual exploitation or molestation by caretakers or other individuals.

Assessment findings:

A. Physical abuse

1. unexplained burns, bruises and fractures

2. bald spots on scalp

3. fear of parents

4. lack of crying when approached by stranger

B. Emotional abuse

1. speech disorders

2. habit disorders (sucking, biting)

3. learning disorders

4. suicide attempts and stow-aways

C. Sexual abuse

1. difficulty walking or sitting

2. torn, stained or bloody underclothing

3. pain, swelling or itching of the genitals

4. bruises, blleding or laceration in the genital area or anal area

5. secretive

6. aspects of sexual molestation in drawings, games, fantasies

D. neglect – the gravest of all child abuse

1. inadequate weight gain

2. poor hygiene

3. consistent hunger

4. delinquency

5. reports of lack of child supervision

6. constant fatigue

C. Out of home placement

Transition independent living separate from family. Behavioral or social problems experienced are similar to that of children of poverty and homelessness

Reasons for out of home placement

a. parent misconduct

b. other parent-related reasons like disability or temporary absence

c. child misconduct like delinquencies, substance abuse and behavioral problems

Types of out of home placements:

a. shelters

b. family foster homes

c. mental health treatment facilities

d. correctional facilities

e. chemical dependency facilities

D. Children of alcoholics

Many children of alcoholics not only feel unloved, but unlovable. Some suffer from sexual and physical abuse, which reinforces these feelings.

Problems of children of alcoholics

guilt
embarrassment
anger
depression
inability to have close relationship

Course Outline: prelims | midterm | finals