Aidan is 18 years and due to complete his final year of A Levels at sixth form college. Aidan lives with his mother Iris, a single mum and hotel manager, and a younger brother Jonathan aged 15.

Iris has observed a change in Aidan’s behaviour since receiving his mock results for his A levels exams in which he received good grades.  Although his teachers report good progress, Aidan felt very disappointed with his results and has become very irritable. His brother Jonathan complains that Aidan doesn’t come out with him to play football anymore and gives the excuse that he is too tired and has to study for getting into university.  Aidan’s peers say that he has become very distressed, he has started to hyperventilate and asks to be excused from class more frequently.  One of his teachers has suggested he goes to see the school nurse to get ‘checked over’.

• What are the key signs and symptoms Aidan presents with?
• How does this affect his family life and school life?

Answer: In order for health practitioners to assess the signs and symptoms of anxiety, they will need to take time to gather information about the individual before attempting to confirm a diagnosis. Assessment may require the use of specific validated questionnaires designed to screen the child for evidence of anxiety symptoms. 

For mild to moderate signs and symptoms, treatment may take the form of a psychotherapy intervention, such as cognitive behaviour therapy (CBT), which can be an effective approach for management of anxiety disorders. This therapy can be adapted for children of 6 years of age and older. It can be used with individuals, groups and families. However, for children with more severe signs and symptoms of anxiety, drug therapy interventions may also be needed, which may include selective serotonin reuptake inhibitors (SSRIs).  A combination of CBT and drug therapy is said to be most effective in the management of anxiety. Evidence on multi modal approaches continues to develop.

Consider the role of the children’s nurse in safeguarding children and young people who may be considering suicide:

• How prepared would you be for having this discussion with a friend, family member or young person?
• Would you know how to contact assistance if you needed support/advice, at any hour of the day or night?

Answer: Consult your education provider, local Trust, Citizens Advice Bureau for a list of suicide awareness training and awareness courses (such as STORM, ASIST, ALERT). 

Access and read the Suicide Intervention Strategy Plan for your country/jurisdiction.

Be aware of your Safeguarding responsibilities both as a citizen and a nurse.

Many organisations exist which aim to help tackle the issues around suicidal ideation across the age ranges. Consult the websites of these organisations for more information on how to deal with suicidal thoughts and feelings (your own or others)

• Papyrus
• Samaritans
• Pips

www.wellatschool.org/

Mike, a senior nurse practitioner, schedules a home visit to a family whose youngest son Tom, 12 years, has oppositional defiant disorder (ODD) and has been exhibiting an escalation in verbally aggressive behaviour resulting in him throwing a vase at his father. Mike arranged for Tom and his parents to come to the CAMHs Unit for an initial assessment.

Answer:

Assessment and Interventions

The observation assessment showed that Tom’s parents found it very hard to be firm with him.  Both parents became very frustrated and wanted to leave the observation room.  Significantly, Mike and the consultant found that Tom appeared to have trouble with understanding any instructions from his parents.  Mike suggested that Tom be assessed for reading and language ability by the school educational psychologist. This report suggested there were problems with learning and a cognitive assessment by the Child and Adolescent Mental Health Unit was then scheduled. On Mike’s next visit to Tom’s home, he was able to explain to Tom’s parents why Tom was becoming so aggressive This was related to   language problems which showed he did not actually understand most instructions.  Mike was able to go through some parent education and training skills with Tom’s parents to show them practical examples of how to give clear simple sequential instructions which Tom could better understand.