Ch. 23: Children and Adolescents Flashcards
Intro
It is often difficult to determine whether a child’s behavior indicates emotional problems
Intellectual Developmental Disorder (IDD)
Intellectual developmental disorder (IDD) has its onset prior to age 18 years and is characterized by impairments in measured intellectual performance and adaptive skills across multiple domains
IDD
- 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
Predisposing factors to IDD
- Genetic factors (errors of metabolism, chromosomal disorders, single gene abnormalities)
- Disruptions in embryonic development (30%) –> Alcohol, drugs, maternal illnesses, infections during pregnancy, pregnancy complications
- Pregnancy and perinatal factors (10%): fetal malnutrition, viral or other infections, trauma or complications that deprive infant of oxygen, premature birth
- General med conditions (5%): infections, poisonings, physical traumas
- Sociocultural and other mental disorders (15 - 20%): Deprived of nurturing and social stimulation, impoverished environments, severe mental disorders such as autism
Assessment of IDD (severity of IDD) know this
- The extent of severity of IDD may be measured by the client’s IQ level:
- Four levels:
1. Mild (50 - 70 IQ, 6th grade)
2. Moderate (like 2nd grade level)
3. Severe (20 - 35 IQ, Complete supervision, young toddler behavior)
4. Profound (below 20 IQ, might even be bedbound, very severe)
Planning/implementation for IDD. Families need to recieve info regarding:
- The scope fo the client’s condition
- Realistic expectations and client potentials
- Methods for modifying behavior as required
- Community resources from which they may seek assistance and support
Autism spectrum disorder
- ASD is characterized by a withdrawal of the child into the self and into a fantasy world of his or her own creation
- Prevalence is about 1 in 59 children
- ASD occurs more often in boys than in girls
- Onset occurs in early childhood
- ASD often runs a chronic course
Predisposing factors to ASD
- Neuro: abnormalities in brain structure or function, role of neurotransmitters under investigation
- Genetics: Familial association, chromosomal involvement
- Perinatal influences: maternal asthma or allergies
- Increased risk does not equal cause
Assessment of ASD
- Impairment in social interaction
- Impairment in communication and imaginative activity
- Restricted activities and interests
- About 1/3 are nonverbal
Pharmacological intervention for ASD
- Two medications approved by the FDA: Risperidone and Aripiprazole
- Targeted for the following symptoms: Aggression, deliberate self-injury, temper tantrums, quickly changing moods
- Dosage is based on weight of the child and the clinical response
(ASD) common side effects of risperidone
- Drowsiness
- Increased appetite
- Nasal congestion
- Fatigue
- Constipation
- Drooling
- Dizziness
- Weight gain
Common side effects of aripiprazole
- Sedation
- fatigue
- Weight gain
- Vomitting
- Somnolence
- Tremor
ASD Pharm: Less common but more serious possible side effects of risperidone and aripiprazole
- NMS
- TD
- Hyperglycemia
- EPS
- Metabolic disorder
ADHD
Essential features of ADHD include developmentally inappropriate degrees of inattention, impulsiveness, and hyperactivity
ADHD categorized by clinical presentation:
- Combined type (meeting the criteria for both inattention and hyperactivity/impulsivity)
- Predominantly inattentive presentation
- Predominantly hyperactive/impulsive presentation
Predisposing factors to ADHD
- Bio: Genetics, biochemical theory, anatomical influences, prenatal, perinatal, and postnatal factors
- Environmental influences: Lead, diet
- Psychosocial influences: disorganized or chaotic fam environments, maternal mental disorder, or paternal criminality, low socioeconomic status, unstable foster care
Assessment of ADHD
- Difficulty in performing age-appropriate tasks
- Highly distractible
- Extremely limited attention span
- Impulsive
ADHD comorbidity
- Comorbid psychiatric disorders are prevalent with ADHD. Common ones include:
- Oppositional defiant disorder
- Conduct disorder
- Anxiety
- Depression
- Bipolar disorder
- Substance use disorder
Comorbidity continued
- Depression and anxiety may be treated concurrently with ADHD
- Substance use disorder and bipolar disorder must be stabilized before beginning treatment for ADHD
Psychopharmacological intervention for ADHD
- CNS stimulants
- EXP: Dextroamphetamine, methamphetamine, lisdexamfetamine, methylphenidate, dexmethylphenidate, dextroamphetamine/amphetamine mixture.
- S/E: Insomnia, anorexia, weight loss, tachycardia, decrease in rate of growth and development
Details of pharm treatment for ADHD
- CNS stimulants…
- Children on ADHD drugs had a higher risk of injury-related hospital admissions
- Monitor cardiovascular functioning
- Psychiatric symptoms may worsen
- A complete discussion of medications used to treat ADHD can be found in chapter 23. Know that a drug “holiday” may be necessary to determine medication effectiveness and need for continuation.
Non-Stimulant drugs for ADHD include:
- Atomoxetine
- Buprion
- Anti-hypertensive drugs (Clonidine, guanfacine)
Tourette’s Disorder
- Essential feature: presence of multiple motor tics and one or more vocal tics
- Onset may be as early as 2 years, but occurs most commonly around age 6 or 7
- The disorder is more common in boys than in girls
Predisposing factors of tourette’s disorder
- bio: Genetics, biochemical factors, structural factors
- Environment: Complications of pregnancy, low birth weight, head trauma, carbon monoxide poisoning, encephalitis
Assessment of tourette’s disorder
- Simple motor tics include eye blinking, neck jerking, shoulder shrugging, and facial grimacing
- Complex motor tics include squatting, hopping, skipping, tapping, and retracing steps
More assessment info on tourette’s disorder
- Vocal tics include words or sounds such as squeaks, grunts, barks, sniffs, snorts, coughs, and, in rare instances, a complex vocal tic involving the uttering of obscenities
- Palilalia
- Echolalia
Pharmacological intervention for Tourette’s disorder is most effective when it is combined with…
…other therapy, such as behavioral therapy, individual counseling or psychotherapy, and family therapy
Common meds used for tourette’s disorder
- Antipsychotics: Haloperidol, pimozide, risperidone, olanzapine, ziprasidone
- Alpha agonists: Clonidine, guanfacine
Oppositional defiant disorder
Oppositional defiant disorder (ODD) is characterized by a persistent pattern of angry mood and defiant behavior that occurs more frequently than is usually observed in individuals of comparable age and developmental level and interferes with social, educational, or vocational activities.
ODD predisposing factors
- bio: Role has not been fully established
- Family: If power and control are issues for parents, or if they exercise authority for theri won needs, a power struggle can be established between the parents and the child, which sets the stage for the dev. of ODD.
Assessment of ODD
- Passive aggressive behaviors
- Stubbornness, procrastination
- resistance to directions
- temper tantrums, fighting, and argumentativeness
- Impaired interpersonal relationships
- More in slide 49
These kids don’t believe that they have an issue
Conduct disorder
- Like antisocial personality disorder
- With this disorder, there is a persistent pattern of behavior in which the basic rights of others and major age-appropriate societal norms or rules are violated.
- Childhood-onset type
- Adolescent-onset type
Predisposing factors to conduct disorder
- Genetics, temperament, Neurobio factors possible (dysregulation in norepinephrine/serotonin; increased testosterone)
- Psychosocial: Aggression found to be principle cause of peer rejection
- Family: Parental rejection, inconsistent management with harsh punishment, parental sociopathy, lack of parental supervision
Family influences of conduct disorder
- Frequent changes in residence
- Economic structures
- Parents with antisocial personality disorder, alc dependance
Assessment
- A lack of remorse
- May not finish school, or hold down a job
- Sexual permissiveness
- violation of rights of others and use of physical aggression
Separation anxiety disorder
- Essential feature: Excessive anxiety concerning separation from those to whom the individual is attached
- Exceeds that which is expected for the person’s developmental level and interferes with social, academic, occupational, or other areas of functioning
Assessment of separation anxiety disorder
- Onset may occur as early as preschool age, rarely as late as adolescence
- child has difficulty separating from the parent
- Separation results in tantrums, crying, screaming, complaints of physical problems, and clinging behaviors.
General therapeutic approaches for separation anxiety disorder
- Behavioral therapy
- Family therapy (both child and fam)
- Group therpay
- Pscy phram
