Chapter 53: Psychosocial Problems in Children and Families

The material distinguishes between internalizing disorders, where distress manifests through internal emotional pain, somatic symptoms, and social withdrawal, and externalizing disorders characterized by impulsive, aggressive, or disruptive outward behaviors. Major internalizing conditions discussed include depression, anxiety disorders, posttraumatic stress responses, and obsessive-compulsive patterns, while externalizing presentations encompass attention-deficit hyperactivity disorder, oppositional defiant behaviors, and conduct disturbances. The chapter addresses critical pediatric mental health concerns including adolescent suicide as a leading preventable cause of death and nonsuicidal self-injury as a maladaptive coping strategy. Eating disorders receive detailed exploration, contrasting the severe restrictive patterns and medical complications of anorexia nervosa with the binge-purge cycles of bulimia and the multifactorial etiology of childhood obesity involving genetic, metabolic, behavioral, and environmental contributors. Substance use patterns in youth are examined, including the increasing prevalence of nicotine vaping and cannabis use, alongside the progressive stages of addiction development. A substantial section addresses child maltreatment identification and intervention, encompassing physical abuse, emotional harm, sexual exploitation, and neglect as violations affecting child development and psychological adjustment. The chapter equips nursing professionals with assessment competencies including mental status examinations and evidence-based screening instruments for early detection. Treatment modalities integrate pharmacological interventions with psychotherapeutic approaches such as cognitive-behavioral therapy and interpersonal therapy, emphasizing the nurse's responsibility in promoting family resilience, providing anticipatory guidance, and implementing trauma-informed care to mitigate long-term developmental and behavioral sequelae.