Child and Adolescent Development Flashcards by Dyan Jones

a development disorder with onset prior to age 18 yrs, characterized by impairments in measured intellectual performance and adaptive skills across multiple domains

Intellectual disability disorder (IDD)

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The etiology of intellectual disability maybe primarily biological, primarily psychosocial, or a combination or unknown.
“is a syndrome that represents a final common pathway produced by a variety of factors that injure the brain & affect its normal development”

Predisposing Factors for Neurodevelopment disorders

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Implicated in approx 5% of the cases;

-Inborn errors of metabolism, such as Tay-Sachs disease, phenylketonuria, and hyperglycinemia
-Chromosomal disorders; ie. Down Syndrome and Klinefelter syndrome
-Single gene abnormalities, ie tuberous sclerosis and neurofibromatosis

Genetic Factors

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Accounts for 30% of IDD cases:

Damages may occur in response to:
1. Toxicity assoc. with maternal ingestion of alcohol or other drugs.
2. Maternal illnesses and infections during pregnanay.
3. Complications of pregnancy, such as toxemia and uncontrolled diabetes.

Disruptions in Embryonic Development

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Account for approx. 10% of cases of IDD
Can be cause by the following:
-fetal malnutrition, viral or other infections during pregnancy
-Trauma or complications of the birth process that result in deprivation of oxygen to the infant.
-Premature birth.

Pregnancy and perinatal Factors

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Account for approx 5% of cases of IDD:
Cause by the following:
-Infections, such as meningitis and encephalitis
-Poisionings, such as from insecticides, medications, and lead.
-Physical traumas, such as head injuries, asphyxiation, and hyperpyrexia.

General Medical Conditions Acquired in Infancy and Childhood.

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Account for between 15 and 20 % of cases with IDD
-May be attributed to
Deprivation of nurturance and social stimulation.
Impoverished environments assoc. with poor prenatal and perinatal care and inadequate nurtrition.
Severe mental disorders, such as autism spectrum disorders

Sociocultural Factors and other mental disorders

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Four levels have been delineated:
mild, 50-70 IQ
moderate, 35-49 IQ
severe, 20-34 IQ
profound below 20

Nurses must assess strengths as well as limitations in order to encourage the client to be as independent as possible.
Family involvement in planning and implementing care.
Family should receive info regarding scope of condition, realistic expectations, client potential, methods for modifying behavior

Application of nursing process for IDD

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Characterized by a withdrawal of the child into the self and into a fantasy world of his/her own creation.

Autism Spectrum Disorder

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1 in 88 children. 4.5x more likely in boys.

Onset early childhood, with symptoms persistent into adulthood.

Facts about Autism

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Abnormalities in major brain structures.
Enlargement in temporal lobe white matter, and an increase in surface area in the temporal, frontal, and parieto-occiptial lobes.
Role of neurotransmitters; serotonin, dopamine, and epinephrine, (currently under investigation)

Neurological Implications of Autism

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Medical conditions that have been assoc. with ASD
-tuberous sclerosis, fragile X syndrome, maternal rubella, congenital hypothyroidism, phenylketonuria, Down Syndrome, neurofibromatosis, and Angelman’s syndrome.

Physiological Implications of Autism

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Strong genetic factor
possible chromosomes implicated 2, 7, 15, 16 and 17

Women who suffer from asthma or allergies around the time of pregnancy are at increased risk of having a child with ASD

Genetic implicated of Autism & Prenatal influences

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Impairment in social interaction
Impairment in communication and imaginative activity
Restricted activities and interests

Symptomology of ASD

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aimed at protection of the child from self-harm, and improvement in social functioning, verbal communication, and personal identity.

Nursing intervention for ASD

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Targets behaviors such as aggression, deliberate self-injury, temper tantrums, and quickly changing moods.
1. risperidone (Risperdal. in children and adolescents 5 to 16yrs old)
-dosage based on weight and clinical response
-common side effects: drowsiness, increased appetite, nasal congestion, fatigue, constipation, drooling, dizziness, and weight gain.
2. Aripiprazole (Abilify. in children 6 to 17 yr old)
-dosage is initiated at 2mg/day. possibly increased to 5mg//day at intervals of no less than 2 weeks, up to max of 15mg/day)
Common side effects: sedation, fatigue, weight gain, vomiting, somnolence, and tremor.
Possible Serious side effects, such as neuroleptic malignant syndrome, tardive dyskinesia, hyperglycemia, extrapyramidal symptoms, and diabetes.

PsychoPharmacology Intervention for ASD

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Developmentally inappropriate degrees of inattention, impulsiveness, and hyperactivity.

Attention Deficit/Hyperactivity Disorder ADHD

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Combined Type (meeting the criteria for both inattention and hyperactiity/impulsivity)
Predominantly hyperactive/impulsive presentation

ADHD is further categorized

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Abnormal levels of dopamine, norepinephrine, and possibly serotonin have been implicated.

Adhd biochemical theory influences

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~Biological Influences
Genetics; Chromosomal links
-Biochemical theory
-Anatomical influences
-Prenatal, perinatal and postnatal factors
~Environmental influences
-Environmental Lead
-Diet factors
-Psychosocial Influences
-Disorganized, chaotic families
-high degree of psychosocial stress, maternal mental disorder, paternal criminality, low socioeconomic status, and unstable foster care

Predisposing factors of ADHD

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Alterations in specific areas of the brain have been implicated in individuals with ADHD. These areas include the prefrontal lobes, basal ganglia, caudate nucleus, globus pallidus, and cerebellum.

Anatomical Influences ADHD

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Prenatal factors include maternal smoking and alcohol intake during pregnancy.

Prenatal Factors ADHD

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Perinatal factors include prematurity, signs of fetal distress, prolonged labor, and perinatal asphyxia.

Perinatal Factors ADHD

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cerebral palsy, seizures, and CNS trauma or infections.

Postnatal Factors ADHD

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environmental lead, diet factors; including food dyes, additives, and sugar

Environmental Factors ADHD

chaotic family environment high degree of social stress, maternal mental disorder, paternal criminality, low socioeconomic status, and unstable foster care

Psychosocial influences of ADHD

- Highly distractable with extremely limited attention span - difficulty forming satisfactory interpersonal relationships - low frustration tolerance and outbursts of temper - excesssive levels of activity, restlessness, and fidgeting

Symptomology of ADHD

Oppositional defiant disorder, conduct disorder, anxiety, depression, bipolar disorder, and substance use disorder.

Co-morbid psychiatric disorders for ADHD

protection from injury due to excessive hyperactivity improvement in social interaction self-esteem compliance with task expectations

Nursing interventions for ADHD

``` Central nervous system stimulants: -Amphetamines -Dextroamphetamine sulfate -Metamphetamine -Lisdexamphetamine -Dextroamphetamine/amphetamine mixtures Others: Methylphenidate -Dexmethylphenidate ``` Effects children with ADHD: increased attention span, control of hyperactive behavior, and improvement in learning ability. Side effects: insomnia, restlessness, palpitations, tachycardia, anorexia, weightloss, tolerance, new or worsened psychiatric symptoms, temporary decrease in rate of growth and development. Drug holiday: attempted periodically

Psychopharmacological intervention for ADHD

Clonidine; Guanfacine Exact mechanism by which these medications produce the therapeutic effect in ADHD is unclear Side effects: palapitations or tachycardia (clonidine); bradycardia; constipation, dry mouth; sedation, rebound syndrome (do not discontinue abruptly)

Alpha Agonists (ADHD)

A selective norepinephrine reuptake inhibitor; -exact mechanism in treatment for ADHD is unknown. Side effects: nausea and vomiting, decreasing appetite, weight loss, constipation, insomnia, increased blood pressure and heart rate, severe liver damage, and new or worsened psychiatric symptoms

Atomoxetine (ADHD)

A nonselective reuptake inhibitor Exact mechanism in treatment of ADHD is unknown Side effects: tachycardia, dizziness, shakiness, insomnia, nausea, anorexia, and weight loss. -(Individuals with a hx of seizures or eating disorders should not take this medicine)

Bupropion (ADHD)

presence of multiple motor tics and one or more vocal tics. -onset can be as early as age 2 years, but the disorders occurs most commonly during childhood ( ~6 to 7 yrs) More common in boys

Tourette's Disorder

Abnormalitites in levels of dopamine, serotonin, dynorpin, gamma-aminobutyric acid, acetylcholine, and norepinephrine

Tourettes disorder

dysfunction in the area of the basal ganglia. | correlation between smaller size of corpus callosum and tourettes

Biochemical factors in tourettes

``` Complications of pregnancy (ie. severe nausea and vomiting or excessive stress) Low birth weight head trauma carbon monoxide poisioning encephalitis ```

Environmental factors of tourettes

Simple motor tics including eye blinking, neck jerking, shoulder shrugging, and facial grimacing. Complex motor tics include: squatting, hopping, tapping, and retracing steps. Vocal tics may also include repeating one's own sounds or words (called palilalia) or repeatin the words of others (called echolalia)

Symptomology of Tourettes

Vocal tics; repeating of one's own sounds or words

palilalia

aimed to protect client and others, improvement in social interactionm and improvement in self-esteem

Nursing intervention of Tourettes

most effective when it is combined with other forms of therapy, such as behavior therapy, individual counseling or psychotherapy, and family therapy. Most common meds are: -Haloperidol (Haldol) Because of side effects, this medication should be reserved for children with severe symptoms or with symptoms that impede their ability to function in school, socially, or within their family setting. -Pimozide: Similar in response rate and side effect profile to haloperidol. Used only with severe cases. Not recomm. for 12 & under Atypical antipsychotics: Risperidone (Risperdal) olanzapine (Zyprexa) ziprasidone (Geodon) Weight gain and hyperglycemia may be troublesome side effects, and ziprasidone has been assoc. with increased risk of QTc interval prolongation Alpha Agonists (clonidine, guanfacine) Sometimes used as drug of first choice because of favorable side-effects profile and because they are often effective for co-morbid symptoms of ADHD, anxiety and insomnia. They should not be perscribed with preexisting cardiac or vascular disease, and should not be discontinued abruptly.

Pharmacological intervention with Tourette's Disorder

``` Haloperidol (Haldol) Pimozide Atypical antipsychotics: Risperidone (Risperdal) olanzapine (Zyprexa) ziprasidoe (Geodon) Alpha Agonists: Clonidine guanfacine ```

Pharmacology for Tourette's Disorder

Characterized by a persistent pattern of angry mood and defiant behavior that occur more frequently than is usually observed in individuals of comparable age and developmental level, and interfers with social, educational, or vocational activites

Oppositional Defiant Disorder (ODD)

Biological Influences;role has not been fully established. Family Influences: If power and control are issues for parets, or if they exercise authority for their own needs, a power struggle can be established between the parents and child, which sets the stage for the development of ODD.

Predisposing factors of ODD

passive-aggressive, exhibited by stubbornness, procrastination, disobedience, carelessness, negativism, testing of limits, resistance to directions, deliberately ignoring the communication of others, and unwillingness to compromise. - running away, school avoidance, school underachievement, temper tantrums, fighting, and argumentativeness. - interpersonal relationships are impaired and school performance is often unsatisfactory.

Symptomology of ODD

aimed at compliance with therapy, acceptance of responsibility for own behavior, increase in self-esteem, and improvement in social interactions

Nursing interventions for ODD

A persistent pattern of behavior in which the basic rights of others and major age-appropriate societal norms or rules are violated. 2 subsets: Childhood onset type Adolescent onset type

Conduct Disorder

defined by the onset of at least one criterion characteristic of conduct disorder prior to age 10

Childhood onset type of Conduct Disorder

defined by the absence of any criteria characteristic of conduct disorder prior to age 10

Adolescent onset type of Conduct Disorder

``` Biological Influences -Genetics Temperament Biochemical Factors Psychosocial Influences Peer relationships Family influences ```

Predisposing Factors of Conduct Disorder

children born with "difficult" temperaments were found to have a significantly higher degree of aggressive behavior later in life

temperament of Conduct disorder

Alterations in levels of norepinephrine and serotonin have been implicated. Studies of the involvement of elevated levels of testosterone have been reported.

Biochemical factor Conduct disorder

having poor peer relations during childhood has been implicated in the etiology of later deviance.

Psychosocial Influences | Peer relationships

The following family dynamics may contribute to the development of conduct disorders: Parental rejection Inconsistent management with harsh discipline Early institutional living Frequent shifting of parental figures Large family size Absent father Parents with antisocial personality disorder or alcohol dependence Marital conflict and divorce Inadequate communication patterns Parental permissiveness

Family Influences of Conduct disorder

Physical aggression in the violation of the rights of others Use of drugs or alcohol Sexual permissiveness Use of projection as a defense mechanism Low self-esteem manifested by "tough guy" image Inability to control anger Low academic achievement Problems with inattentiveness, impulsiveness, and hyperactivity

Symptomology of Conduct Disorder

aimed at the protection of others from the client's physical aggression; improvement in social interaction and self-esteem; and client acceptance of responsibility for his/her own behavior

Nursing Interventions for Conduct disorder

Excessive fear or anxiety concerning separation from those to whom the indiv. is attached.

Separation Anxiety Disorder

``` Genetics; family with anxiety Temperament Environmental Influences -stressful life events Family Influences ```

Biological Influences of Separation Anxiety Disorder

Possible over attachment to the mother Separation conflicts between parent and child Overprotection by parents Transfer of fears and anxieties from parents to child through role modeling.

Family Influences of Separation Anxiety Disorder

Onset of separation anxiety disorder may occur as early as preschool age, rarely as late as adolescence. -Child has difficulty separating from mother Separations results in tantrums, crying, screaming, complaints of physical problems, and "clinging" behaviors School reluctance or refusal Fear of sleeping away from home Fear of harm to self or attachment figure nightmares may occur Phobias and depressed mood are not uncommon

Symptomology of Separation Anxiety Disorder

maintaining anxiety at moderate level or below; improvement in social interaction; and development of adaptive coping strategies that prevent maladaptive symptoms of anxiety in response to separation from attachment figure.

Nursing interventions of Separation Anxiety Disorder

``` Behavior Therapy Family Therapy Group Therapy Psychoeducational groups Psychopharmacology ```

General Therapeutic Approaches

assoc. with maintaining attention, organization and executive function. Also serves to modulate behavior inhibition, with serotonin as the predominant central inhibiting neurotransmitters for this function.

Prefrontal cortex