One common dilemma faced by psychiatric nurse practitioners is determining
who the “client” is. Given that children are typically brought for treatment by
their parents, describe how the psychiatric nurse practitioner would respond to
a child who discloses they are indulging in illicit behavior and asks you not to tell
his or her parents.
3. Internalizing Disorders
Can children in elementary school become depressed? After studying Module 3:
Lecture Materials & Resources, address the following in a well-written discussion post:
• What makes childhood depression difficult to assess?
• Identify your ethnicity and culture, then explain your answer by comparing your
cultural beliefs regarding depression and anxiety and those of another ethnicity
and culture
Sample Answer
The Dilemma of Confidentiality with a Child Client
In psychiatric practice, when a minor client discloses illicit behavior and requests confidentiality from their parents, the psychiatric nurse practitioner (PNP) must navigate a complex ethical and legal dilemma governed by the principles of confidentiality and the duty to protect.
Identifying the Client
For a child, the "client" is often considered the treatment unit, which includes both the child (the identified patient) and the parents/guardians (who provide legal consent and financial responsibility).
Minors and Confidentiality: Children have a right to some confidentiality, but it is limited. In most jurisdictions, parents/guardians retain the legal right to information about their child's treatment and well-being, as they are ultimately responsible for the child's health and safety.
PNP Response to the Disclosure
When a child discloses illicit behavior and requests secrecy, the PNP's response should follow these steps:
Assess the Risk: The PNP must first determine if the disclosed behavior involves imminent danger to the child or others.
High-Risk Examples (Duty to Break Confidentiality): Suicidal ideation with a plan, severe self-harm, current drug/substance abuse that could lead to overdose, severe physical violence, or any activity that legally constitutes child abuse or neglect.
Low-Risk Examples (Confidentiality Maintained): Minor rule-breaking, experimental drug use without addiction risk, or sharing sensitive thoughts/feelings.
Refer to the Consent Agreement: At the beginning of treatment, the PNP should have established a confidentiality contract with the child and parents. This contract typically outlines that information will be kept confidential unless it involves risk of serious harm. The PNP should gently remind the child of this limit.
Encourage Disclosure: For behaviors that are not immediately life-threatening but require parental intervention (e.g., occasional marijuana use, truancy), the PNP should help the child process the disclosure and encourage them to tell the parents themselves. The PNP can offer to facilitate this conversation.
Mandatory Reporting: If the behavior meets the threshold for mandated reporting (e.g., child abuse or neglect), the PNP is legally and ethically obligated to report this to the appropriate protective services and inform the parents/guardians, regardless of the child's request.
Informing the Child: If the PNP determines they must disclose the information to the parents (because it falls under the "duty to protect" clause), they must inform the child first that they are breaking confidentiality and explain why (i.e., safety concerns). This preserves the therapeutic alliance as much as possible.
The guiding principle is always safety first: the PNP's primary duty is to protect the child from harm.
Internalizing Disorders: Childhood Depression
Can Children in Elementary School Become Depressed?
Yes, children in elementary school can become depressed. While it may not present in the same ways as adult or adolescent depression, Major Depressive Disorder (MDD) is a recognized childhood mental illness.
The presentation is often characterized by internalizing symptoms (emotions directed inward) rather than the classic sad mood or anhedonia (loss of pleasure).
What Makes Childhood Depression Difficult to Assess?
Assessing depression in elementary-aged children is challenging for several reasons:
Developmental Limitations: Young children often lack the cognitive ability and vocabulary to articulate complex, internal emotional states like "hopelessness" or "sadness." They may simply describe feeling "bad" or "bored."
Somatic Complaints: Children frequently express emotional distress through physical complaints (somatic symptoms) such as stomachaches, headaches, or fatigue, which can mimic medical conditions and lead to misdiagnosis.
Behavioral Masking: Instead of appearing sad, depressed children often display irritability, temper tantrums, clinging behavior, social withdrawal, or school refusal. These externalizing behaviors can be mistaken for behavioral problems, ADHD, or defiance, leading clinicians to miss the underlying mood disorder.
Parental Reliance: Assessment is heavily reliant on parent and teacher reports. If adults aren't aware of typical developmental milestones or have their own bias, they may minimize or misinterpret the child's symptoms.
Cultural Beliefs Regarding Depression and Anxiety
As an AI, I do not have an ethnicity or culture. For the purpose of this academic exercise, I will assume the identity of a PNP of European American culture and compare these beliefs with those commonly found in Filipino/Filipino American culture.