Ch. 23 Children/Adolescents

Question 1

Intellectual Developmental Disorder is…
Onset
How is it tested?

Answer 1

• Has its onset prior to age 18 years and is characterized by impairments in measured intellectual performance and adaptive skills across multiple domains.
• General intellectual functioning is measured by both clinical assessment and a person’s performance on IQ tests.
• Adaptive functioning refers to the person’s ability to adapt to requirements of activities of daily living and the expectations of his or her age and cultural group.
• A diagnosis requires the presence of deficits in intellectual (cognitive and learning functions) and adaptive (such as independent functioning, communication, and social) domains that began during the developmental period.

Question 2

Mild IDD is characterized by…
IQ
ABILITY TO PERFORM SELF-CARE ACTIVITIES
COGNITIVE/EDUCATIONAL CAPABILITIES
SOCIAL/COMMUNICATION CAPABILITIES
PSYCHOMOTOR CAPABILITIES

Answer 2

50-70 IQ
- Capable of independent living, with assistance during times of stress.
- Capable of academic skills to sixth-grade level. As adult can achieve vocational skills for minimum self-support.
- Capable of developing social skills. Functions well in a structured, sheltered setting.
- Psychomotor skills usually not affected, although may have some slight problems with coordination.

Question 3

Moderate IDD is characterized by…
IQ
ABILITY TO PERFORM SELF-CARE ACTIVITIES
COGNITIVE/EDUCATIONAL CAPABILITIES
SOCIAL/COMMUNICATION CAPABILITIES
PSYCHOMOTOR CAPABILITIES

Answer 3

35-49 IQ
- Can perform some activities independently. Requires supervision.
- Capable of academic skill to second-grade level. As adult may be able to contribute to own support in sheltered workshop.
- May experience some limitation in speech communication. Difficulty adhering to social convention may interfere with peer relationships.
- Motor development is fair. Vocational capabilities may be limited to unskilled gross motor activities.

Question 4

Severe IDD is characterized by…
IQ
ABILITY TO PERFORM SELF-CARE ACTIVITIES
COGNITIVE/EDUCATIONAL CAPABILITIES
SOCIAL/COMMUNICATION CAPABILITIES
PSYCHOMOTOR CAPABILITIES

Answer 4

20-34 IQ
- May be trained in elementary hygiene skills. Requires complete supervision.
- Unable to benefit from academic or vocational training. Benefits from systematic habit training.
- Minimal verbal skills. Wants and needs often communicated by acting-out behaviors.
- Poor psychomotor development. Able to perform only simple tasks under close supervision.

Question 5

Profound IDD is characterized by…
IQ
ABILITY TO PERFORM SELF-CARE ACTIVITIES
COGNITIVE/EDUCATIONAL CAPABILITIES
SOCIAL/COMMUNICATION CAPABILITIES
PSYCHOMOTOR CAPABILITIES

Answer 5

Below 20
- No capacity for independent functioning. Requires constant aid and supervision.
- Unable to benefit from academic or vocational training. May respond to minimal training in self-help if presented in the close context of a one-to-one relationship.
- Little, if any, speech development. No capacity for socialization skills.
- Lack of ability for both fine and gross motor movements. Requires constant supervision and care. May be associated with other physical disorders.

Question 6

Nursing Diagnoses associated with IDD

Answer 6

• Risk for injury related to altered physical mobility or aggressive behavior
• Self-care deficit related to altered physical mobility or lack of maturity
• Impaired verbal communication related to developmental alteration
• Impaired social interaction related to speech deficiencies or difficulty adhering to conventional social behavior
• Delayed growth and development related to isolation from significant others, inadequate environmental stimulation, genetic factors
• Anxiety (moderate to severe) related to hospitalization and absence of familiar surroundings
• Defensive coping related to feelings of powerlessness and threat to self-esteem
• Ineffective coping related to inadequate coping skills secondary to developmental delay

Question 7

IDD: Risk for Injury related to altered physical mobility or aggressive behavior
Goal
■ Patient will not experience injury.
Interventions

Answer 7

1. Create a safe environment for the patient.
2. Ensure that small items are removed from area where patient will be ambulating and that sharp items are out of reach.
3. Store items that patient uses frequently within easy reach.
4. Pad side rails and headboard of patient with history of seizures.
5. Prevent physical aggression and acting-out behaviors by learning to recognize signs that patient is becoming agitated.

Question 8

IDD: Self-Care Deficit related to altered physical mobility or lack of maturity
Goal
■ Patient will be able to participate in aspects of self-care.
■ Patient will have all self-care needs met.
Interventions

Answer 8

1. Identify aspects of self-care that may be within patient’s capabilities. Work on one aspect of self-care at a time. Provide simple, concrete explanations. Offer positive feedback for efforts.
2. When one aspect of self-care has been mastered to the best of patient’s ability, move on to another. Encourage independence but intervene when patient is unable to perform.

Question 9

IDD: Impaired Verbal Communication related to developmental alteration
Goal:
■ Patient will establish trust with caregiver and a means of communication of needs.
■ Patient’s needs are being met through established means of communication.
■ If patient cannot speak or communicate by other means, needs are met by caregiver’s anticipation of patient’s needs.
Interventions

Answer 9

1. Maintain consistency of staff assignment over time.
2. Anticipate and fulfill patient’s needs until satisfactory communication patterns are established. Learn (from family, if possible) special words client uses that are different from the norm. Identify nonverbal gestures or signals that patient may use to convey needs if verbal communication is absent. Practice these communications skills repeatedly.
   - Some children with intellectual disability, particularly at the severe level, can learn only by systematic habit training.

Question 10

IDD: Impaired Social Interaction related to speech deficiencies or difficulty adhering to conventional social behavior
Goal:
■ Patient will attempt to interact with others in the presence of trusted caregiver.
■ Patient will be able to interact with others using behaviors that are socially acceptable and appropriate to developmental level.
Interventions

Answer 10

1. Remain with patient during initial interactions with others on the unit.
2. Explain to other patients the meaning behind some of client’s nonverbal gestures and signals. Use simple language to explain to patient which behaviors are acceptable and which are not. Establish a procedure for behavior modification with rewards for appropriate behaviors and aversive reinforcement for inappropriate behaviors.

Question 11

Autism Spectrum Disorder is…
Onset

Answer 11

• ASD is characterized by a withdrawal of the child into the self and into a fantasy world of his or her own creation.
• Encompasses a broad spectrum of diagnoses that included autistic disorder, Rett’s disorder, childhood disintegrative disorder, pervasive developmental disorder not otherwise specified, and Asperger’s disorder.
• The diagnosis is adapted to each individual by clinical specifiers (e.g., level of severity, verbal abilities) and associated features (e.g., known genetic disorders, epilepsy, intellectual disability)
• ASD is characterized by a withdrawal of the child into the self and into a fantasy world of his or her own creation.
• ASD occurs more often in boys than in girls.
• Onset occurs in early childhood.
• ASD often runs a chronic course.

Question 12

DSM-V Criteria for Autism Spectrum Disorder

Answer 12

A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive):
- 1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
- 2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
- 3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.

Question 13

ASD
Severity is based on social communication impairments and restricted, repetitive patterns of behavior:

Answer 13

A. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history:
- 1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypes lining up toys or flipping objects, echolalia, idiosyncratic phrases).
- 2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).
- 3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
- 4. Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).

Question 14

ASD
Impairment in Social Interaction:

Answer 14

Impairment in Social Interaction:
- Difficulty forming interpersonal relationships
- Little interest in people
- Do not respond to others’ attempts at interaction.
- Infants: aversion to affection and physical contact.
- Toddlers: attachment to a significant adult may be either absent or manifested as exaggerated adherence behaviors
- Childhood: lack of spontaneity manifested in less cooperative play, less imaginative play, and fewer friendship
- Higher functioning children may recognize their difficulty with social skills even though they may desire friendship.

Question 15

Nursing Diagnoses for ASD

Answer 15

• Risk for self-mutilation or self-injury related to neurological, cognitive, or social deficits.
• Impaired social interaction related to inability to trust; neurological alterations, evidenced by lack of responsiveness to or interest in people
• Impaired verbal communication related to withdrawal into the self; neurological alterations, evidenced by inability or unwillingness to speak; lack of nonverbal expression
• Disturbed personal identity related to neurological alterations; delayed developmental stage, evidenced by difficulty separating own physiological and emotional needs and personal boundaries from those of others

Question 16

ASD
Risk for self-mutilation or self-injury related to neurological, cognitive, or social deficits.
Goal:
■ Patient will demonstrate alternative behavior (e.g., initiating interaction between self and nurse) in response to anxiety within specified time.
■ Patient will not harm self.
Interventions

Answer 16

1. Work with the child on a one-to-one basis.
2. Try to determine if the self-mutilative behavior occurs in response to increasing anxiety, and if so, to what the anxiety may be attributed.
3. Try to intervene with diversion or replacement activities and offer self to the child as anxiety level starts to rise.
4. Protect the child when self-mutilative behaviors occur. Devices such as a helmet, padded hand mitts, or arm covers may provide protection when the risk for self-harm exists.

Question 17

ASD
Impaired social interaction related to inability to trust; neurological alterations, evidenced by lack of responsiveness to or interest in people
Goal:
■ Patient will demonstrate trust in one caregiver (as evidenced by facial responsiveness and eye contact) within specified time
■ Patient will initiate social interactions (physical, verbal, nonverbal) with caregiver by time of discharge from treatment.
Interventions

Answer 17

1. Assign a limited number of caregivers to the child. Ensure that warmth, acceptance, and availability are conveyed.
2. Provide child with familiar objects, such as familiar toys or a blanket. Support child’s attempts to interact with others.
3. Give positive reinforcement for eye contact with something acceptable to the child (e.g., food, familiar object). Gradually replace with social reinforcement (e.g., touch, smiling, hugging).

Question 18

ASD
Impaired verbal communication related to withdrawal into the self; neurological alterations, evidenced by inability or unwillingness to speak; lack of nonverbal expression
Goal:
■ Patient will establish trust with one caregiver (as evidenced by facial responsiveness and eye contact) by specified time
■ Patient will establish a means of communicating needs and desires to others.
Interventions

Answer 18

1. Maintain consistency in assignment of caregivers.
2. Anticipate and fulfill the child’s needs until communication can be established.
3. Seek clarification and validation.
4. Give positive reinforcement when eye contact is used to convey nonverbal expressions.

Question 19

ASD
Disturbed Personal Identity related to neurological alterations; delayed developmental stage, evidenced by difficulty separating own physiological and emotional needs and personal boundaries from those of others
Goal:
■ Patient will name own body parts as separate and individual from those of others.
■ Patient will develop ego identity (evidenced by ability to recognize physical and emotional self as separate from others) by time of discharge from treatment.
Interventions

Answer 19

1. Assist child to recognize separateness during self-care activities, such as dressing and feeding.
2. Assist the child in learning to name own body parts. This can be facilitated by the use of mirrors, drawings, and pictures of the child. Encourage appropriate touching of, and being touched by, others.

Question 20

Psychopharmacological Intervention: ASD
Targeted for the following symptoms:
Age range

Answer 20

Medications approved by the FDA
- Risperidone (Risperdal) in children and adolescents 5 to 16 years
- Aripiprazole (Abilify) in children and adolescents 6 to 17 years
Targeted for the following symptoms:
- Aggression
- Deliberate self-injury
- Temper tantrums
- Quickly changing moods

Question 21

Risperidone (Risperdal) Side Effects

Answer 21

Drowsiness
Increased appetite
Nasal congestion
Fatigue
Constipation
Drooling
Dizziness
Weight gain
Serious side effects: Neuroleptic malignant syndrome, tardive dyskinesia, hyperglycemia, and diabetes.

Question 22

Aripiprazole (Abilify) Side Effects

Answer 22

Sedation
Fatigue
Weight gain
Vomiting
Somnolence
Tremor

Question 23

ADHD is…

Answer 23

• Essential features of ADHD include developmentally inappropriate degrees of inattention, impulsiveness, and hyperactivity.
• ADHD can follow child into adulthood
• These children are highly distractible and unable to contain stimuli. Motor activity is excessive, and movements are random and impulsive.

Question 24

Assessment of ADHD

Answer 24

Difficulty in performing age-appropriate tasks
Highly distractible
Extremely limited attention span
Impulsive
Difficulty forming satisfactory interpersonal relationships
Demonstrates behaviors that inhibit acceptable social interaction
Disruptive and intrusive in group endeavors
Excessive levels of activity, restlessness, and fidgeting
Accident prone
Low frustration tolerance and temper outbursts

Question 25

Comorbid psychiatric disorders are prevalent with ADHD. Common ones include:

Answer 25

Oppositional defiant disorder
Conduct disorder
Anxiety
Depression
Bipolar disorder
Substance use disorders

Question 26

DSM-V Criteria ADHD
1. Inattention: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:

Answer 26

a. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate).
b. Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading).
distraction).
c. Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction).
d. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked).
e. Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized, work; has poor time management; fails to meet deadlines).
f. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers).
g. Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, or mobile telephones).
h. Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts).
i. Is often forgetful in daily activities (e.g., chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments).

Question 27

DSM-V Criteria ADHD
2. Hyperactivity and Impulsivity: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities.

Answer 27

a. Often fidgets with or taps hands or feet or squirms in seat.
b. Often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in place).
c. Often runs about or climbs in situations where it is inappropriate.
d. Often unable to play or engage in leisure activities quietly.
e. Is often “on the go,” acting as if “driven by a motor” (e.g., is unable to be or uncomfortable being still for extended time, as in restaurants, meetings; may be experienced by others as being restless and difficult to keep up with).
f. Often talks excessively.
g. Often blurts out an answer before a question has been completed (e.g., completes people’s sentences; cannot wait for turn in conversation).
h. Often has difficulty waiting his or her turn (e.g., while waiting in line).
i. Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission; for adolescents or adults, may intrude into or take over what others are doing).

Question 28

Nursing Diagnoses for ADHD

Answer 28

• Risk for injury related to impulsive and accident-prone behavior and the inability to perceive self-harm
• Impaired social interaction related to intrusive and immature behavior
• Low self-esteem related to dysfunctional family system and negative feedback
• Noncompliance with task expectations related to low frustration tolerance and short attention span

Question 29

ADHD
Risk for injury related to impulsive and accident-prone behavior and the inability to perceive self-harm
Goal:
■ Patient will be free of injury.
Interventions

Answer 29

1. Ensure that patient has a safe environment. Remove from immediate area objects on which patient could injure self as a result of random, hyperactive movements.
2. Identify deliberate behaviors that put the child at risk for injury. Institute consequences for repetition of this behavior.
3. If there is risk of injury associated with specific therapeutic activities, provide adequate supervision and assistance, or limit patient’s participation if adequate supervision is not possible.

Question 30

ADHD
Impaired social interaction related to intrusive and immature behavior
Goal:
■ Patient will interact in age-appropriate manner with nurse in one-to-one relationship within 1 week.
■ Patient will observe limits set on intrusive behavior and will demonstrate ability to interact appropriately with others.
Interventions

Answer 30

1. Develop a trusting relationship with the child. Convey acceptance of the child separate from the unacceptable behavior.
2. Discuss with patient those behaviors that are and are not acceptable. Describe in a matter-of-fact manner the consequences of unacceptable behavior. Follow through.
3. Provide group situations for patient.

Question 31

ADHD
Low self-esteem related to dysfunctional family system and negative feedback
Goal
■ Patient will independently direct own care and activities of daily living within 1 week.
Interventions
■ Patient will demonstrate increased feelings of self-worth by verbalizing positive statements about self and exhibiting fewer demanding behaviors.

Answer 31

1. Ensure that goals are realistic.
2. Plan activities that provide opportunities for success.
3. Convey unconditional acceptance and positive regard.
4. Offer recognition of successful endeavors and positive reinforcement for attempts made. Give immediate positive feedback for acceptable behavior.

Question 32

ADHD
Noncompliance with task expectations related to low frustration tolerance and short attention span
Goal
■ Patient will participate in and cooperate during therapeutic activities.
■ Patient will be able to complete assigned tasks independently or with a minimum of assistance.
Interventions

Answer 32

1. Provide an environment for task efforts that is as free as possible of distractions.
2. Provide assistance on a one-to-one basis, beginning with simple, concrete instructions.
3. Ask patient to repeat instructions to you.
4. Establish goals that allow patient to complete a part of the task, rewarding completion of each step with a break for physical activity.
5. Gradually decrease the amount of assistance given, while assuring patient that assistance is still available if deemed necessary.

Question 33

Psychopharmacological Intervention: ADHD

Answer 33

CNS Stimulants = first line of treatment
Examples: Dextroamphetamine, methamphetamine, lisdexamfetamine, methylphenidate, dexmethylphenidate, dextroamphetamine/amphetamine mixture

Question 34

Side effects of CNS stimulants

Answer 34

Overstimulation, Restlessness, Insomnia
Anorexia, Weight loss,
Palpitations, Tachycardia,
Decrease in rate of growth and development
Tolerance, physical and psychological dependence
Headache,
Increased blood pressure
Abdominal pain
Anxiety

Question 35

ADHD
Amphetamines
Drugs

Answer 35

• Dextroamphetamine sulfate (Dexedrine; Dextrostat)
• Methamphetamine (Desoxyn)
• Lisdexamfetamine (Vyvanse)

Question 36

ADHD
Amphetamine Mixtures
Drugs

Answer 36

• Dextroamphetamine/amphetamine (Adderall; Adderall XR)Adderall XR-ODT

Question 37

ADHD
Alpha Agonists
Drugs

Answer 37

• Clonidine (Catapres)
• Guanfacine (Tenex; Intuniv)

Question 38

ADHD
Miscellaneous
Drugs

Answer 38

• Methylphenidate (Ritalin; Ritalin-SR; Ritalin LA; Methylin; Methylin ER; Metadate ER; Metadate CD; Concerta; Daytrana)
• Atomoxetine (Strattera)
• Bupropion (Wellbutrin; Wellbutrin SR; Wellbutrin XL)

Question 39

Bupropion Side Effects

Answer 39

Insomnia, dry mouth, tremor, seizures (dose dependent)
Palpitations, tachycardia
Anorexia, weight loss
Nausea and vomiting
Constipation
Headache
Dizziness
Insomnia or sedation
Increased blood pressure

Question 40

Atomoxetine (Strattera) Side Effects

Answer 40

Palpitations, tachycardia
Anorexia, weight loss
Nausea and vomiting
Constipation
Severe liver damage
Headache
Upper abdominal pain
Cough
Dry mouth, constipation
Increase in heart rate and blood pressure
Fatigue.

Question 41

Alpha Agonists
- Clonidine (Catapres)
- Guanfacine (Tenex; Intuniv)
Side Effects

Answer 41

Bradycardia
Palpitations
Constipation
Dry mouth
Sedation
Rebound syndrome

Question 42

Predisposing Factors to IDD
Genetics

Answer 42

Inborn errors of metabolism
- Tay Sachs, phenylketonuria, and hyperglycinemia
Chromosomal disorders
- Down Syndrome, Klinefelter’s syndrome
- Single gene abnormalities: fragile X syndrome, tuberous sclerosis, and neurofibromatosis

Question 43

Predisposing Factors to IDD
Disruptions in embryonic development
Pregnancy and perinatal factors

Answer 43

Disruptions in embryonic development
- Toxicity associated with maternal ingestion of alcohol or other drugs
- Maternal illnesses and infections during pregnancy
- Complications of pregnancy
Pregnancy and perinatal factors
- Fetal malnutrition, viral or other infections during pregnancy
- Trauma or complications during delivery that deprive the infant of oxygen
- Premature birth
- Placenta previa
- Prolapse of umbilical cord

Question 44

Predisposing Factors to IDD
General medical conditions acquired in infancy or childhood
Sociocultural and other mental disorders

Answer 44

General medical conditions acquired in infancy or childhood
- Infections (examples: meningitis, encephalitis)
- Poisonings (examples: insecticides, medications, lead)
- Physical traumas (for example, head injuries, asphyxiation, hyperpyrexia)
Sociocultural and other mental disorders
- Deprivation of nurturance and social stimulation
- Impoverished environments associated with poor prenatal and perinatal care and inadequate nutrition
- Severe mental disorders such as Autism Spectrum Disorder

Question 45

Predisposing Factors: ASD
Neurobiological Implications
Genetics
Prenatal and Perinatal Influences

Answer 45

Neurological implications
- Abnormalities in brain structure or function
Genetics
- Familial association
- Chromosomal involvement
Prenatal and Perinatal influences
- Maternal asthma or allergies
- Advanced maternal age
- Fetal exposure to depakote (valproate)
- Gestational diabetes and bleeding

Question 46

Predisposing Factors: ADHD
Biological influences
Prenatal, perinatal, and postnatal factors

Answer 46

Genetics
Biochemical theory
Anatomical influences
Prenatal, perinatal, and postnatal factors
- Low birth weight, trauma, exposed to early infancy infections

Question 47

Predisposing Factors: ADHD
Environmental Influences
Psychosocial Influences

Answer 47

Environmental influences
- Environmental lead
- Dietary factors
Psychosocial influences
- Disorganized or chaotic family environments
- Maternal mental disorder or paternal criminality
- Low socioeconomic status
- Unstable foster care

Question 48

Evaluation IDD

Answer 48

Has the patient:
■Remained free from injury?
■Had self-care needs fulfilled? Been able to fulfill some of these needs independently?
■Been able to communicate needs and desires so that he or she can be understood?
■Learned to interact appropriately with others?
■Accepted constructive feedback and discontinued inappropriate behavior when regressive behavior surfaces?
■Maintained anxiety at a manageable level?
■Learned new coping skills through behavior modification?
■Demonstrated evidence of increased self-esteem because of the accomplishment of these new skills and adaptive behaviors?

Question 49

Evaluation ASD

Answer 49

Has the child:
■Been able to establish trust with at least one caregiver?
■Remained free from mutilative behaviors or other self-harm?
■Attempted to interact with others?
■Improved in his or her ability to maintain eye contact?
■Established a means of communicating his or her needs and desires to others? Have all self-care needs been met?
■Demonstrated an awareness of self as separate from others?
■Accepted touch from others and been appropriate in touching others?

Question 50

Evaluation ADHD

Answer 50

Has the child:
■Remained free from injury?
■Been able to establish a trusting relationship with the primary caregiver?
■Responded to limits set on unacceptable behaviors?
■Been able to interact appropriately with others?
■Been able to verbalize positive statements about self?
■Been able to complete tasks independently or with a minimum of assistance? Can he or she follow through after listening to simple instructions?
■Been able to apply self-control to decrease motor activity?

Question 51

ASD
Impairment in Communication and Imaginative Activity

Answer 51

• Language may be totally absent or characterized by immature structure or idiosyncratic utterances whose meaning is clear only to those who are familiar with the child’s past experiences.
• Nonverbal communication, such as facial expression or gestures, may be absent or socially inappropriate.
• Misinterpreted as being deaf as a result of their lack of response to sounds, whereas other children may overreact to sound or other stimuli
• In some cases, children with ASD demonstrate special abilities, such as fluent reading skills while still in preschool

Question 52

ASD
Restricted Activities and Interests

Answer 52

• Even minor changes in the environment are often met with resistance or sometimes with agitated irritability.
• Attachment to, or extreme fascination with, objects that move or spin (e.g., fans) is common.
• Stereotyped body movements (hand-clapping, rocking, whole-body swaying) and verbalizations (repetition of words or phrases) are typical.
• Diet abnormalities may include eating only a few specific foods or consuming an excessive amount of fluids.
• Behaviors that are self-injurious, such as head banging or biting the hands or arms, may be evident.