# Situation: The nurse works in the child and adolescent mental health clinic of a provincial hospital, where parents bring their children for assessment and follow-up. A 10-year-old boy with mild intellectual developmental disorder is learning to wash his hands before meals. Which teaching approach is BEST?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630085  
> 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: The nurse works in the child and adolescent mental health clinic of a provincial hospital, where parents bring their children for assessment and follow-up.

A 10-year-old boy with mild intellectual developmental disorder is learning to wash his hands before meals. Which teaching approach is BEST?

## 보기

1. Break it into steps, show each, and praise only at the end
2. Break it into steps, show each, and praise every success **✔ 정답**
3. Show the whole task, then have him copy it and praise him
4. Break it into steps and give him a checklist to read

**정답: 2**

## 해설

Skills for a child with intellectual developmental disorder are taught by task analysis: the skill is broken into small steps, each step is demonstrated and practiced, and every success is reinforced right away. Each other choice drops one of these elements: immediate reinforcement of each step, breaking the task down, or demonstration within his abilities.

## 심화 해설

Core Teaching Principle

For a child with mild intellectual developmental disorder (IDD), learning a self-care skill such as handwashing requires a structured behavioral approach. The most effective method is task analysis, which involves breaking the skill into small, sequential steps, demonstrating each step, and providing immediate positive reinforcement after every successful attempt. This aligns with the AACAP practice parameter, which emphasizes that treatment and skill-building in children with IDD require modifications to standard techniques, including simplified instruction and consistent behavioral reinforcement [1]. Handwashing is a hygiene task that benefits from this same principle: each component—turning on the tap, wetting hands, applying soap, rubbing, rinsing, drying—is taught and reinforced separately before chaining them together.

Reinforcement must occur after each step, not only at the end, because children with IDD often have difficulty connecting a delayed reward to a specific action. When praise is withheld until the entire sequence is complete, the child may not understand which part of the behavior earned approval. Immediate feedback strengthens the association between the demonstrated step and the child’s attempt, making learning faster and more durable.

Watch out! Option 1 removes the critical element of step-by-step reinforcement. Option 3 fails to break the task into manageable parts, which can overwhelm a child with IDD who has limited working memory and sequencing ability. Option 4 relies on reading a checklist, which is inappropriate for a child with mild IDD whose reading comprehension and abstract symbol processing are often below age level.

| Teaching Element | Why It Matters in IDD | Correct Approach |
| --- | --- | --- |
| Task breakdown | Reduces cognitive load; each step is a discrete, achievable goal | Break handwashing into small steps (turn tap, wet hands, soap, rub, rinse, dry) |
| Demonstration | Visual modeling supports imitation, which is stronger than verbal instruction alone | Show each step while naming it simply |
| Reinforcement timing | Immediate praise links the action to the reward; delayed praise loses the association | Praise every successful step, not only the final result |
| Mode of instruction | Concrete, hands-on learning outperforms written or abstract instruction | Avoid checklists; use demonstration and guided practice |

The systematic review on hygiene education supports the value of structured, stepwise training for infection prevention behaviors, noting that effective hygiene instruction requires clear task decomposition and feedback . Although that review focuses on extended reality technologies, the underlying educational principle—breaking hygiene tasks into teachable components with immediate feedback—is consistent with behavioral methods used for children with IDD. Similarly, the pediatric assessment guideline highlights that children with IDD benefit from interventions that are individualized and developmentally appropriate, including simplified teaching strategies and caregiver involvement .

Key point! Task analysis plus immediate, step-by-step reinforcement is the evidence-based standard for teaching self-care skills to children with intellectual developmental disorder. The correct option combines all three essential components: breaking the task into steps, demonstrating each step, and praising every success.References (research sources)

- [1]Practice Parameter for the Assessment and Treatment of Psychiatric Disorders in Children and Adolescents With Intellectual Disability (Intellectual Developmental Disorder).Research articleSiegel M, McGuire K, Veenstra-VanderWeele J, Stratigos K, King B, American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality Issues (CQI) (2020) · DOI: 10.1016/j.jaac.2019.11.018

## 임상 시나리오

Teaching Self-Care in Intellectual Developmental DisorderTask Analysis & Immediate Reinforcement
For a child with intellectual developmental disorder, teaching a skill like handwashing requires task analysis. Break the task into small, sequential steps, demonstrate each step, and have the child practice it.

Provide positive reinforcement after every successful attempt. Immediate praise strengthens the link between the specific action and the reward, which is essential for learning.

CautionDo not delay praise until the whole task is finished. Children with IDD often struggle to connect a delayed reward to a specific step, slowing skill acquisition.

## 핵심 개념

- **Task Analysis** — Breaking a complex skill into small, sequential steps to teach it effectively.
- **Positive Reinforcement** — Providing a reward immediately after a desired behavior to increase its frequency.
- **Intellectual Developmental Disorder** — A neurodevelopmental disorder with deficits in intellectual and adaptive functioning.
- **Chaining** — Linking individually learned steps together to form a complete, complex behavior.
- **Adaptive Functioning** — Skills needed for daily living, including self-care, communication, and social participation.

## 같은 주제 문제

- [Situation: A 38-year-old woman with bipolar I disorder is admitted to the psychiatric ward…](https://mymerci.kr/pages/nclex_q.php?qn_id=629966)
- [Situation: A 38-year-old woman with bipolar I disorder is admitted to the psychiatric ward…](https://mymerci.kr/pages/nclex_q.php?qn_id=629967)
- [Situation: A 38-year-old woman with bipolar I disorder is admitted to the psychiatric ward…](https://mymerci.kr/pages/nclex_q.php?qn_id=629968)
- [Situation: A 38-year-old woman with bipolar I disorder is admitted to the psychiatric ward…](https://mymerci.kr/pages/nclex_q.php?qn_id=629969)
- [Situation: The nurse in a community mental health program leads a psychoeducation session …](https://mymerci.kr/pages/nclex_q.php?qn_id=629970)
- [Situation: The nurse in a community mental health program leads a psychoeducation session …](https://mymerci.kr/pages/nclex_q.php?qn_id=629971)
- [Situation: The nurse in a community mental health program leads a psychoeducation session …](https://mymerci.kr/pages/nclex_q.php?qn_id=629972)
- [Situation: A 29-year-old factory worker is admitted to the psychiatric unit of a general h…](https://mymerci.kr/pages/nclex_q.php?qn_id=629973)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._