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
Responding to a Child's Confidential Disclosure
When a child discloses illicit behavior and asks for confidentiality, the Psychiatric Nurse Practitioner (PNP) operates under a conflict between the minor's right to confidentiality and the legal/ethical duty of mandated reporting (especially regarding child safety) and the therapeutic alliance with the family.
The PNP's initial response and subsequent action would generally involve:
Immediate Clarification of Confidentiality Limits: At the outset of therapy, the PNP should have already established the limits of confidentiality with both the child and parents. When the disclosure occurs, the PNP must reiterate these limits immediately and non-judgmentally. They must clearly state that while most information is confidential, they are mandated reporters and must break confidentiality if the child is in imminent danger of serious harm to self or others, or if the illicit behavior falls under mandatory reporting laws (e.g., severe physical/sexual abuse, child neglect).
mmediate Clarification of Confidentiality Limits: At the outset of therapy, the PNP should have already established the limits of confidentiality with both the child and parents. When the disclosure occurs, the PNP must reiterate these limits immediately and non-judgmentally. They must clearly state that while most information is confidential, they are mandated reporters and must break confidentiality if the child is in imminent danger of serious harm to self or others, or if the illicit behavior falls under mandatory reporting laws (e.g., severe physical/sexual abuse, child neglect).
Assessment of Risk: The PNP must assess the specific nature of the "illicit behavior."
Low-Risk Behavior (e.g., minor shoplifting, experimental substance use not involving high danger): The PNP would discuss the risks of the behavior with the child, emphasize the importance of the parents' involvement for support, and work with the child on how they can disclose the information to their parents. The PNP may act as a mediator but would strive to preserve the child's autonomy in sharing this less dangerous information.
High-Risk Behavior or Mandated Reporting Trigger (e.g., severe substance abuse, suicidal ideation/plan, or abuse/neglect of the child): The PNP's duty to protect the child and/or others overrides confidentiality. The PNP must inform the child that they must tell the parents or appropriate authorities due to safety concerns. This is done with clear, simple, non-punitive language, focusing on safety as the reason for the disclosure.
Collaborative Disclosure (When possible): For any disclosure to parents, the PNP should try to make it a collaborative process, letting the child participate in how and when the parents are informed, if safe to do so. This helps maintain the therapeutic relationship, even when confidentiality is broken.
🧒 Childhood Depression and Cultural Views
Yes, children in elementary school can become depressed (Major Depressive Disorder or other depressive disorders). While once thought to be rare or only manifesting as irritability, clinical criteria can be met in younger children. The worldwide prevalence of mental health conditions among 10–19-year-olds is estimated at one in seven (14.3%), with depression being present in an estimated 1.3% of 10–14-year-olds.
Assessing Childhood Depression Difficulties
Childhood depression is difficult to assess due to several factors:
Developmental Stage: Children often lack the cognitive and linguistic ability to articulate their feelings in the way adults do (e.g., "I feel hopeless" or "I've lost pleasure in life"). Their presentation is often behavioral (irritability, academic decline, somatic complaints like stomachaches or headaches, or increased behavioral problems like defiance) rather than classic adult sadness.
Informant Variability: Different informants (child, parent, teacher) often provide discrepant reports of symptoms. A child might self-report internalizing symptoms like sadness, while parents or teachers report externalizing behaviors like hyperactivity or irritability.
Comorbidity: Depression rarely occurs in isolation in children and frequently co-occurs with anxiety disorders or Disruptive Mood Dysregulation Disorder (DMDD), which can mask or complicate the primary depressive diagnosis.
Contextual Factors: It can be hard to differentiate true depressive symptoms from typical mood fluctuations, emotional reactions to life stress (e.g., parental divorce), or temporary reactions to developmental transitions.