# Situation: A public health nurse trained in the World Health Organization Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) makes a home visit to a 9-year-old boy. His mother says he still cannot dress himself or read simple words, and he has always reached milestones later than his siblings. His growth and nutrition are normal, and he attends a mainstream public school. The nurse plans weekly home visits with his mother for the next 2 months. A developmental disorder is identified. His teacher reports that he is calm and attentive in class. His mother asks for a medicine that will help him learn faster. According to mhGAP-IG, what should the nurse do?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630004  
> language: ko  
> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: A public health nurse trained in the World Health Organization Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) makes a home visit to a 9-year-old boy. His mother says he still cannot dress himself or read simple words, and he has always reached milestones later than his siblings. His growth and nutrition are normal, and he attends a mainstream public school. The nurse plans weekly home visits with his mother for the next 2 months.

A developmental disorder is identified. His teacher reports that he is calm and attentive in class. His mother asks for a medicine that will help him learn faster. According to mhGAP-IG, what should the nurse do?

## 보기

1. Give a daily multivitamin to support his brain development
2. Transfer him to a residential center for children with delays
3. Refer him to a specialist for a medicine to improve his memory
4. Enroll his mother in parent skills training in the community **✔ 정답**

**정답: 4**

## 해설

For developmental delay or disorder, mhGAP-IG says not to offer pharmacological treatment. Care consists of psychoeducation, parent skills training, carer support, liaison with the school, links with community-based rehabilitation, and follow-up at least every 3 months, while keeping the child in a mainstream school and avoiding institutional care.

## 심화 해설

Core mhGAP-IG principle for developmental disorders
The mhGAP-IG explicitly advises against offering pharmacological treatment for developmental delay or disorder. No multivitamin, memory-enhancing drug, or other medicine accelerates learning in a child with a developmental disorder. The correct response is to provide psychosocial and family-based care.

Why parent skills training is the priority
In this case, the boy has a developmental disorder but is calm and attentive in class, attends a mainstream public school, and has normal growth and nutrition. These are protective factors. The mother is asking for a medicine because she wants him to learn faster. The nurse should redirect that request toward an evidence-based, non-pharmacological intervention.

The WHO Parents Skills Training (PST) programme is recommended as a key intervention for developmental disorders and delays under the mhGAP-IG. PST teaches caregivers how to use everyday routines to promote communication, self-care, and learning. For a 9-year-old who still cannot dress himself or read simple words, structured parent-mediated practice at home is more appropriate than medication.

Why the other options are incorrect

| Option | Why it is not the mhGAP-IG recommendation |
| --- | --- |
| 1. Daily multivitamin | Growth and nutrition are already normal. A multivitamin does not treat developmental delay or accelerate learning. |
| 2. Residential center | mhGAP-IG emphasizes keeping the child in a mainstream school and avoiding institutional care whenever possible. |
| 3. Specialist for memory medicine | Pharmacological treatment is not offered for developmental disorders under mhGAP-IG. No medication improves memory or learning speed in this context. |

Broader care package under mhGAP-IG
Parent skills training is one component of a comprehensive plan. The nurse should also provide psychoeducation about the developmental disorder, offer carer support, maintain liaison with the school to support the teacher, and link the family with community-based rehabilitation services. Follow-up should occur at least every 3 months.

Key point! The mhGAP-IG approach for developmental disorders is non-pharmacological and family-centered. Parent skills training is the core intervention, delivered in the community while the child remains in mainstream school.

Watch out! A request for medication does not mean medication is indicated. The nurse should validate the mother’s concern but explain that learning gains come from structured caregiver-mediated practice, not drugs.

## 임상 시나리오

mhGAP-IG Developmental Disorder CareNon-pharmacological family-based intervention
For developmental delay or disorder, mhGAP-IG advises against offering pharmacological treatment. No medicine accelerates learning.

Core care includes psychoeducation, parent skills training, carer support, school liaison, and links to community-based rehabilitation.

Keep the child in a mainstream school and follow up at least every 3 months.

CautionDo not recommend multivitamins or memory drugs. Avoid institutional care when family and school support are available.

## 핵심 개념

- **mhGAP-IG** — WHO Mental Health Gap Action Programme Intervention Guide for non-specialist health settings
- **Parent skills training** — Caregiver-mediated intervention using daily routines to promote communication, self-care, and learning
- **Developmental disorder** — Condition with delayed milestones in multiple domains, not treated with medication per mhGAP-IG
- **Psychoeducation** — Providing information about the condition and care strategies to family members
- **Community-based rehabilitation** — Local services supporting participation and skill development for children with disabilities

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