Assignment: Patient Education for Children and Adolescents

NRNP 665 Assignment: Patient Education for Children and Adolescents

Assignment: Patient Education for Children and Adolescents

Generalized anxiety disorder (GAD) is one of the anxiety disorders in children and adolescents. GAD is a constant state of increased anxiety and apprehension. Anxiety disorders in children and adolescents are characterized by worry, fear, or dread that significantly impair a person’s ability to function normally and are disproportionate to the situation (Iani et al., 2019). The following blog seeks to educate caregivers on GAD, including the signs and symptoms, pharmacological and non-pharmacological treatments, appropriate community resources, and referrals.

GAD Signs and Symptoms

The child with GAD will likely have multiple and diffuse worries aggravated by stress. If your child has GAD, you may notice that they have a shortened attention span and maybe hyperactive and restless, or keyed up. In addition, the child may have sleeping difficulties (difficulties initiating or maintaining sleep), sweat excessively, exhibit irritable behavior, and complain of constant fatigue (Bhatia & Goyal, 2018). GAD also presents with physical symptoms, and the child may report muscle aches, stomachaches, and headaches.

Pharmacological and Non-Pharmacological Treatments

Treatment of GAD in children and adolescents has two main approaches, pharmacological and non-pharmacological

Assignment Patient Education for Children and Adolescents

Assignment Patient Education for Children and Adolescents

interventions. Pharmacological treatment is used for patients with severe GAD and those who fail to respond to psychotherapeutic interventions. Anxiolytic drugs include selective serotonin reuptake inhibitors (SSRIs), typically the drugs of choice in children and adolescents (Bushnell et al., 2018). Most children tolerate SSRIs without significant side effects. In addition, Benzodiazepines are prescribed for short-term treatment of anxiety but are not recommended for long-term treatment (Garakani et al., 2020).

Non-pharmacological treatment includes psychotherapy, the first-line treatment for mild to moderate GAD in children and adolescents. Psychotherapies used include behavioral therapy such as exposure-based cognitive-behavioral therapy (CBT). Exposure-based CBT involves systematically exposing the child to the anxiety-triggering situation, but in a graded fashion (Amray et al., 2019). The therapist helps the child remain in the anxiety-provoking situation, which makes them become desensitized and feel less anxious. In mild-moderate GAD cases, behavioral therapy alone is usually sufficient. Mindfulness-Based Psychotherapy is also a non-pharmacological approach used in GAD. It entails using regular mindfulness meditation practices to help the child develop mindfulness skills (Amray et al., 2019).

Community Resources and Referrals

Community resources available for children and adolescents with GAD include organizations such as the American Academy of Child & Adolescent Psychiatry, Child Mind Institute, and Anxiety and Depression Association of America – Anxiety and Depression in Children. The organizations provide information about the condition and how to help a child diagnosed with GAD. In addition, there are online communities where one can learn more about GAD, such as Parenting Anxious Kids, Turn around Anxiety Blog, and Anxiety-Free Child Blog. Children with GAD who do not improve with treatment disorder are referred to a child psychiatrist for more specialized treatment.

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GAD in children and adolescents presents with excessive anxiety/worry and behavioral and physical symptoms. Treatment includes psychotherapy such as CBT and mindfulness-based therapy for mild to moderate exercises. Medications are prescribed for children with severe cases or those who do not respond adequately to psychotherapy.


Amray, A. N., Munir, K., Jahan, N., Motiwala, F. B., & Naveed, S. (2019). Psychopharmacology of Pediatric Anxiety Disorders: A Narrative Review. Cureus11(8), e5487.

Bhatia, M. S., & Goyal, A. (2018). Anxiety disorders in children and adolescents: Need for early detection. Journal of postgraduate medicine64(2), 75–76.

Bushnell, G. A., Compton, S. N., Dusetzina, S. B., Gaynes, B. N., Brookhart, M. A., Walkup, J. T., Rynn, M. A., & Stürmer, T. (2018). Treating Pediatric Anxiety: Initial Use of SSRIs and Other Antianxiety Prescription Medications. The Journal of clinical psychiatry79(1), 16m11415.

Garakani, A., Murrough, J. W., Freire, R. C., Thom, R. P., Larkin, K., Buono, F. D., & Iosifescu, D. V. (2020). Pharmacotherapy of anxiety disorders: current and emerging treatment options. Frontiers in psychiatry, 1412.

Iani, L., Quinto, R. M., Lauriola, M., Crosta, M. L., & Pozzi, G. (2019). Psychological well-being and distress in patients with generalized anxiety disorder: The roles of positive and negative functioning. PloS one14(11), e0225646.


Depression is a mental health disorder characterized by sadness, loss of interest in activities, and depressed or irritable mood severe enough to affect an individual’s ability to function effectively significantly. It is a common mental illness that can occur at any age and affects how individuals feel, thinks, and acts. It can result in emotional or physical problems that can interfere with the individual’s ability to function. There are several depressive disorders which include major depressive disorder, persistent depressive disorder (dysthymia), disruptive mood dysregulation disorder, premenstrual dysphoric disorder, substance/medication-induced depressive disorder, and unspecified depressive disorder (American Psychiatric Association, 2013). This paper aims to discuss persistent depressive disorder (dysthymia), its signs and symptoms, pharmacological and nonpharmacological interventions, and possible community referrals.

Persistent Depressive Disorder (Dysthymia)

Persistent depressive disorder, also called dysthymia, is a combination of chronic major depressive disorder and dysthymic disorder characterized by low mood for most of the day, occurring for at least two years for adults. It can be diagnosed in pediatric patients, either children or adolescents when the depressed or irritable mood is present for at least one year (American Psychiatric Association, 2013). During the 2 or 1 year period of the illness, two or more of the following symptoms such as poor appetite or overeating, insomnia or hypersomnia, low energy, fatigue, low self-esteem, poor concentration, and feelings of hopelessness, must also be present (American Psychiatric Association, 2013). Many factors can trigger the risk of persistent depressive disorder in children or adolescents, such as increased stress, physical or emotional trauma, abuse, neglect, loss of a parent, caregiver, or relationship, health-related problems, developmental or learning disabilities, and substance use.

Signs and Symptoms of Persistent Depressive Disorder

Depression can cause lower quality of life, higher risk of suicide, disability,  and loss of productivity. Unfortunately, depression is often undiagnosed because of failure to recognize the symptoms and seek mental health care (Farid et al., 2020). Individuals with persistent depressive disorder have different symptoms, and they include sadness, low self-esteem, feelings of despair, helplessness or guilt, suicidal thoughts and attempts, sleep problems, problems with appetite, low energy, problems with focus and concentration, irritability, aggression, fatigue, loss of interest in usual activities, running away from home, and feelings of rejection. If your child experiences two of these symptoms, please notify the child’s health care provider, and provide details of the child’s clinical presentation. This disorder can be treated with medications and psychotherapy.

Pharmacological Treatment of Persistent Depressive Disorder (Dysthymia)

There are FDA-approved medications that can be used to treat depression in pediatric patients. They include Escitalopram (Lexapro) for individuals between 12 and 17 years and Fluoxetine (Prozac) for ages between 8 and 17 years.

Escitalopram (Lexapro) and Fluoxetine (Prozac) are antidepressants that belong to the class of medications called the Selective serotonin reuptake inhibitor (SSRIs), used primarily for the treatment of depression and anxiety. These medications work by increasing the chemical serotonin in the brain. Studies have shown that adolescents with persistent depressive disorder treated with these antidepressants showed significant improvement in symptoms, better response, and remission rates. They are generally well-tolerated, and few individuals experience adverse reactions, usually occurring within the first eight weeks (Findling et al., 2013).

Nonpharmacological Treatment of Persistent Depressive Disorder

Persistent depressive disorder can also be treated without the use of medications or by combining medications with therapies. Psychotherapies have been studied and proven to be effective in significantly reducing depressive symptoms and helping patients to develop coping skills to manage these symptoms effectively. The psychotherapies include Cognitive behavioral therapy (CBT), Interpersonal psychotherapy, and the cognitive-behavioral analysis system of psychotherapy.

  • Cognitive Behavioral Therapy (CBT): Individuals suffering from depression are taught cognitive and behavioral skills to help them develop more positive beliefs about themselves, others, and the world. It helps them to learn to value their own feelings, replace behaviors that generate negative feelings with more appropriate behaviors, and modify distorted thoughts and inaccurate reasoning (Bernaras et al., 2019).
  • Interpersonal Psychotherapy: It uses certain behavioral strategies such as problem- solving and social skills training and lasts between 12 and 16 sessions in the most severe cases and between 3 and 8 sessions in milder cases (Bernaras et al., 2019).
  • Cognitive Behavioral Analysis System of Psychotherapy: This therapy combines components of cognitive, behavioral, interpersonal, and psychodynamic therapies. It is developed specifically to treat chronic depression. Patients undergoing this therapy generate more empathic behaviors and identify, change and heal interpersonal patterns related to depression (Bernaras et al., 2019).

Community Resources or Referrals

Several communities and online resources can help promote mental health awareness and provide support to achieve the treatment goals. Transitioning into full recovery without community support services can be overwhelming. The support services can help the individual to deal with the stressors and difficult situations and enhance the chances to function independently and effectively. Some of the community and online resources that can be utilized include the National Alliance on Mental Illness (NAMI), National Institute of Mental Health (NIH), Federation of Families for Children’s Mental Health NJ State Organization (NJ FFCMH), and other groups that can provide services and resources to caregivers parents and their children.

For safety, the patient is to call 911 or talk to someone anytime he experiences intrusive thoughts or unsafe thoughts to harm himself or others. The helplines that can be utilized are:

  • National Alliance on Menatl Illness (NAMI) helpline – 1-800-950-NAMI or
  • National Institute of Mental Health (NIH) helpline – 1-866-615-6464 or
  • Federation of Families for Children’s Mental Health NJ State Organization (NJ FFCMH) helpline – 973-642-8100


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

Bernaras, E., Jaureguizar, J., & Garaigordobil, M. (2019). Child and adolescent depression: A Review of theories, evaluation, instruments, prevention programs, and treatments. Frontiers in Psychology. Retrieved from

Farid, D., Da Costa, D., Afif, W., & Szabo, J. (2020). Undiagnosed depression, persistent depressive symptoms and seeking mental health care: Analysis of immigrant and non-immigrant participants of the Canadian longitudinal study of aging. Epidemiology and Psychiatric Sciences, 29. Retrieved from

Findling, R.L., Robb, A., & Bose, A. (2013). Escitalopram in the treatment of adolescent depression: A Randomized, double-blind, placebo-controlled extension trial. Journal of Child and Adolescent Psychopharmacology, 23 (7), 468-480. Retrieved from


Disruptive mood dysregulation disorder (DMDD) involves persistent irritability and frequent episodes of behavior that is very out of control, with onset at age 6-10 years (Elia, 2021). In this paper, I will be educating about DMDD, which includes the sign and symptoms, pharmacological and nonpharmacological treatments, and community resources.

Sign and Symptoms

To diagnose, patient must not be before age 6 or after age 18 years (Elia, 2021). Sign and symptoms must be ongoing for more than 12 months, with on period more than 3 months without them (Elia, 2021). Sign and symptoms include:

  • Severe recurrent temper outbursts that are grossly out of proportion to the situation and that occurs more than 3 times a week on average (Elia, 2021)
  • Temper outburst that are inconsistent with developmental level (Elia, 2021)
  • An irritable, angry mood present every day for most of the day and observed by others such as teachers, parents and peers (Elia, 2021)

Pharmacological Treatments

DMDD is a newly added diagnosis in DSM-5. Currently, there is not enough literature that reviews the possible treatment options for the cardinal symptoms of DMDD (Tourian et al, 2015). Due to this issue, there is no pharmacological treatment that is FDA approved for DMDD. However, clinicians can prescribe medication such as stimulants, antipsychotics and mood stabilizers that can handle symptoms such as irritability. According to Tapia & John (2018), these medications are used to manage the symptoms but not the condition.

Non-Pharmacological Treatments

            According to Lovering (2021), there are three common nonpharmacological treatments used for DMDD and they are the following:

  • Cognitive Behavioral Therapy (CBTP – can help children cope with their feelings. Can also help kids respond to frustration and anger with the goal to control or reduce the frequency of outburst
  • Dialectical behavior therapy for children (DBT-C) – focuses on emotional and social aspects of living. Can also help them learn relationship strategies as well as personal strategies.
  • Parent training – a technique where they learn to anticipate aggressive behavior and work to prevent it

Community Resources

            According to Uran & Kilic (2020), families dealing with children with DMDD can get more information about the disorder, what it is and how to manage it, from organizations such as Mental Health America and National Alliance on Mental Illness. They (2021) also mentioned going to Substance Abuse and Mental Health Services Administration, who has a referral treatment helpline and get information on treatment services.


In conclusion, dealing with children diagnosed with DMDD can be challenging. It would help families to learn as much information about the disorder and how to manage it. It is good to know that there are resources available.


Elia, J. (2021, April). Depressive Disorders in Children and Adolescents. Merch Manual Professional Version. Retrieved April 1, 2022, from

Lovering, C. (2021, September 27). Treating Disruptive Mood Dysregulation Disorder (DMDD). PsychCentral. Retrieved on April 1, 2022, from

Tapia, V., & John, R. M. (2018). Disruptive Mood Dysregulation Disorder. The Journal of Nurse Practitioners, 14 (8), 573-578.

Tourian, L., LeBoeuf, A., Breton, J. J., Cohen, D., Gignac, M., Labelle, R., Guile, J.M., & Renaud, J. (2015, March 4). Treatment Options for the Cardinal Symptoms of Disruptive Mood Dysregulation Disorder. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 24(1), 41-54.

Anxiety Disorder

At times life can be stressful and can make us anxious. These anxious feelings can come from a problem from work, a test in a class or just trying something new. But an anxiety disorder involves more than just temporary worry. An anxiety disorder is anxiety that does not go away and can worsen over time. It can impede day-to-day activities such as work performance, school performance and even relationships (National Institute of Mental Health, 2018). According to  Vahratian, Blumberg, Terlizzi and Schiller, between August 2020 and February 2021, the rate of adults with new symptoms of an anxiety or a depressive disorder increased from 36.4% to 41.5%, and the percentage of those reporting an undiagnosed mental health care need increased from 9.2% to 11.7%. These percentages reported the largest among adults aged between 18 and 29 years of age and those with less than a high school education.

Signs and Symptoms and Types of Anxiety Disorders

There are many diverse types of anxiety disorders such as general anxiety disorder, selective mutism, social anxiety disorder, substance induced and panic disorder just to name a few. They all share some of the same symptoms with each other but have some characteristics unique to themselves. But the common signs and symptoms of anxiety disorder include feeling nervous, restlessness, tension, having a sense of impending doom, increased heart rate, hyperventilation, sweating, trembling, feeling weak, trouble concentrating or thinking about anything other than the present worry, insomnia, gastrointestinal problems, difficulty controlling worry and avoiding situations that triggers anxiety (Mayo Clinic, 2018). The causes of anxiety disorders are not fully understood. Events such as trauma can be a trigger, but genetics can also be a factor (Mayo Clinic, 2018). Medical problems such as cardiovascular, respiratory problems, drug and alcohol abuse, withdrawal, and pain can also trigger anxiety. Some of the risk factors are trauma, stress, and other mental health comorbidities such as depression.

Pharmacological Treatment

The first line of defense for anxiety disorders are selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) (Garakani et al, 2001). A meta-analysis stated that most SSRIs and SNRIs were more successful than placebo in generalized anxiety disorder, with escitalopram and duloxetine potentially having the largest effect sizes (Garakani et al, 2001). These medications are well-tolerated, with short-lived but manageable side effects like nausea, headache, dry mouth, diarrhea, or constipation. Sexual dysfunction is a more durable and problematic side effect of SSRIs and SNRIs, but these side effects can be controlled with adjunctive care. There is a possibility of patients developing jitteriness and anxiety, because of initial surge of serotonin. Although this anxiety can be controlled by slower adjustment rate or the supplemental use of benzodiazepines.

Non-Pharmacological Treatment

Some of the non-pharmacological treatments can include cognitive behavior therapy. According to Therapist Aid, “cognitive behavioral therapy (CBT) has become the leading treatment for anxiety.” Research indicates that CBT can be a successful treatment for anxiety after as few as eight sessions. It can have a successful rate with or without pharmacological intervention (Therapist Aid, 2016). Some other treatments can include dietary restrictions such as limiting caffeine, eating a balanced diet, avoiding foods high in sugar (including sodas that can be high in caffeine and sugar) and processed foods. Limiting alcohol and nicotine can be beneficial to managing anxiety as well (Therapist Aid, 2016). Drinking more water, getting adequate rest and exercise helps to manage anxiety, also meditation and relaxation techniques such as yoga are extremely beneficial to anxiety reduction.


There are many different resources that a person can use to get help, education, and inspiration for hope against debilitating anxiety. One of the resources called Sanity Break is a site where people share how they cope with anxiety. Organizations like The National Alliance on Mental Illness and The Centers of Disease Control and Prevention, The Division of Mental Health conducts studies and can offer insight on coping mechanisms. There are stigmas that impede therapy for Black American, Asian American, Pacific Islander, Hispanic or Latino, and Indigenous communities. There are organizations such as The Asian Mental Health Collective and The Black Mental Health Alliance. According to Bennington-Castro et al the Inclusive Therapists was created to “center the needs of Black, Indigenous, and People of Color (BIPOC) and the LGBTQIA2S+ community” while respecting the neurodiversity spectrum and advocating for mental health care accessibility for people with disabilities or disabled people.”  The drugs to treat anxiety disorders may not be affordable to some patients so programs like Good Rx, Medical Assistance Tool, Needy Meds, Together Rx Access, and Social Security are viable options to help patients get the medications they need for successful treatment (Bennington-Castro et al, 2021).



Bennington-Castro, J., Vaughn, L., Pugle, M., Upham, B., Konkel, L., Bennington-Castro, J., Chant, I., & Fletcher, J. (2021, April 8). Anxiety resources. Retrieved April 3, 2022, from

Garakani, A., Murrough, J. W., Freire, R. C., Thom, R. P., Larkin, K., Buono, F. D., & Iosifescu, D. V. (1AD, January 1). Pharmacotherapy of anxiety disorders: Current and emerging treatment options. Frontiers. Retrieved April 3, 2022, from

Mayo Foundation for Medical Education and Research. (2018, May 4). Anxiety disorders. Mayo Clinic. Retrieved April 3, 2022, from

Therapist Aid. (2016, April 29). Treating anxiety with CBT (guide). Therapist Aid. Retrieved April 3, 2022, from

U.S. Department of Health and Human Services. (2022). Anxiety disorders. National Institute of Mental Health. Retrieved April 3, 2022, from