Chapter 33: Childhood & Adolescence

Question 1

*****Intellectual Developmental Disorders
Intellectual Disability
(IDD/ID)

Answer 1

Diagnosed through clinical assessment of behaviors, history, and performance on standardized tests.
Significantly below-average intelligence accompanied by impaired adaptive functioning.
The degree of severity is identified by IQ level
1 mild
2 moderate
3 severe
4 profound

Question 2

Autism Spectrum Disorder (ASD)

Answer 2

A disorder that is characterized by impairment in social interaction skills and interpersonal communication and a restricted repertoire of activities and interests

Question 3

Hyperactivity

Answer 3

Excessive psychomotor activity that may be purposeful or aimless, accompanied by physical movements and verbal utterances that are usually more rapid than normal. Inattention and distractibility are common with hyperactive behavior.

Question 4

Impulsiveness

Answer 4

The trait of acting without reflection and without thought to the consequences of the behavior. An abrupt inclination to act (and the inability to resist acting) on certain behavioral urges.

Question 5

Temperament

Answer 5

Personality characteristics that define an individual’s mood and behavioral tendencies. The sum of physical, emotional, and intellectual components that affect or determine a person’s actions and reactions.

Question 6

attention-deficit/hyperactivity disorder (ADHD)

Answer 6

May exhibit symptoms of inattention or hyperactivity and impulsiveness or a combination of the two.
Genetics plays a role in the etiology.
Neurotransmitters that have been implicated include dopamine, norepinephrine, and serotonin.
Maternal smoking during pregnancy has been linked to hyperactive behavior in offspring.
CNS stimulants, alpha agonists, atomoxetine, and bupropion are commonly used for treatment.

Question 7

Tourette’s disorder

Answer 7

The presence of multiple motor tics and one or more vocal tics.
Common medications used include haloperidol, pimozide, clonidine, guanfacine, and atypical antipsychotics such as risperidone, olanzapine, and ziprasidone.

Question 8

Oppositional defiant disorder

Answer 8

Characterized by a pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures that occurs more frequently than is usually observed in individuals of comparable age and developmental level.

Question 9

Conduct disorder

Answer 9

Repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated.

Question 10

Separation anxiety disorder

Answer 10

Excessive anxiety concerning separation from the home or from those to whom the person is attached.
May have temperamental characteristics present at birth that predispose them to the disorder.

Question 11

Therapeutic approaches for kids

Answer 11

Behavior therapy, family therapy, group therapies (including music, art, crafts, play, and psychoeducation), and psychopharmacology.

Question 12

In an effort to help the child with mild to moderate intellectual developmental disorder develop satisfying relationships with others, what nursing interventions is appropriate?

Answer 12

Set limits on behavior that is socially inappropriate.

Question 13

What group is commonly used for drug management of the child with ADHD?

Answer 13

CNS stimulants (e.g., methylphenidate [Ritalin])

Question 14

What medications is used to treat Tourette’s disorder?

Answer 14

Haloperidol (Haldol)

Question 15

General intellectual functioning

Answer 15

measured by a person’s performance on IQ tests.

Question 16

Adaptive functioning

Answer 16

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

Question 17

Five major predisposing factors to IDD

Answer 17

1. Hereditary factors
2. Early changes in embryonic development
3. Pregnancy and perinatal factors
4. General medical conditions acquired in infancy or childhood
5. Environmental influences and other mental disorders

Question 18

*****Assessment IDD

Answer 18

• Assess and focus on each client’s strengths and individual abilities.
• Knowledge regarding level of independence in the performance of self-care activities is essential to the development of an adequate plan for the provision of nursing care.

Question 19

*****emotional problem

Answer 19

exists if behavioral manifestations:

1. Are not age appropriate
2. Deviate from cultural norms
3. Create deficits or impairments in adaptive functioning

Question 20

*****Autistic Disorder / Autism Spectrum Disorder

Answer 20

-Early onset: before 30 months
-Disturbance in social relations
-Clinical symptoms
Withdrawal into self and fantasy world
Abnormal development in social interaction and communication
Restricted activity and interests.
Delayed language, or concrete thinking
Pronoun reversals and abnormal intonation

Question 21

*****Stereotypical Autistic behavior

Answer 21

Repetitive rocking
Hand flapping
Insistence on sameness
Self-injurious behavior

Question 22

ADHD

Answer 22

• Inattention
• Hyperactivity
• Impulsiveness that is pervasive and inappropriate for developmental level
• 6% of school-aged children
• Boys more affected than girls

Question 23

*****ADHD Assessment

Answer 23

• Difficulties in performing age-appropriate tasks
• Highly distractible
• Extremely limited attention spans
• Impulsivity
• Have difficulty forming satisfactory interpersonal relationships
• Demonstrate behaviors that inhibit acceptable social interaction
• Disruptive and intrusive in group endeavors
• “Perpetual motion machines”
• Accident prone

Question 24

*****ADHA Implementation

Answer 24

• Educating the family about treatment and behavioral strategies
• Helping families cope
• Managing developmental and academic issues
• Teaching social skills
• Improving self-esteem

Question 25

*****ADHD Implications

Answer 25

• Assess the client’s mental status for changes in mood, level of activity, degree of stimulation, and aggressiveness.
• Ensure that the client is protected from injury. Limit stimuli and keep environment as quiet as possible to discourage overstimulation.
• Reduce adverse effect of anorexia, medication may be administered immediately after meals.
• To prevent insomnia, administer last dose at least 6 hours before bedtime.
• Administer sustained-release forms in the morning.
• The client should be weighed regularly while on CNS stimulants because of the potential for anorexia and weight loss and for the temporary interruption of growth and development.
• In children with behavior disorders, a drug “holiday” should be attempted periodically.

Question 26

*****Other Disruptive Behavior Disorders

Answer 26

*Oppositional defiant disorder*
Disobedient
Argumentative
Angry outbursts
Low frustration tolerance
Tendency to blame others

*Conduct disorder*
Serious violations of social norms
Aggressive behavior
Destruction of property
Cruelty to animals

Question 27

*****Separation Anxiety Disorder Nursing Diagnosis

Answer 27

• Anxiety (severe) related to family history, temperament, over attachment to parent, negative role modeling
• Ineffective coping related to unresolved separation conflicts and inadequate coping skills
• Impaired social interaction related to reluctance to be away from attachment figure

Question 28

Obsessive-Compulsive Disorder

Answer 28

• Intrusive thoughts and/or ritualized behaviors
• 2-3% of adults affected: reported onset in childhood

Treatment

• Medications
• Behavior therapy: exposure and response prevention
• Cognitive behavioral therapy

Question 29

*****Tourette’s Syndrome

Answer 29

The essential feature of Tourette’s syndrome is the presence of multiple motor tics and one or more vocal tics.
Tics may appear simultaneously or at different periods during the illness.
Presence of tics causes marked distress.

Question 30

*****Tic Disorders and Tourette Disorder

Nursing Management

Answer 30

Interventions
Counseling and education for patient
Individual psychotherapy
Education for parents
Consultation for schools