Child and Adolescent Development Flashcards
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)
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
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
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
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
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.
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
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
Characterized by a withdrawal of the child into the self and into a fantasy world of his/her own creation.
Autism Spectrum Disorder
1 in 88 children. 4.5x more likely in boys.
Onset early childhood, with symptoms persistent into adulthood.
Facts about Autism
- 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
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
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
- Impairment in social interaction
- Impairment in communication and imaginative activity
- Restricted activities and interests
Symptomology of ASD
aimed at protection of the child from self-harm, and improvement in social functioning, verbal communication, and personal identity.
Nursing intervention for ASD
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
Developmentally inappropriate degrees of inattention, impulsiveness, and hyperactivity.
Attention Deficit/Hyperactivity Disorder ADHD
Combined Type (meeting the criteria for both inattention and hyperactiity/impulsivity) Predominantly hyperactive/impulsive presentation
ADHD is further categorized
Abnormal levels of dopamine, norepinephrine, and possibly serotonin have been implicated.
Adhd biochemical theory influences
~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
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
Prenatal factors include maternal smoking and alcohol intake during pregnancy.
Prenatal Factors ADHD
Perinatal factors include prematurity, signs of fetal distress, prolonged labor, and perinatal asphyxia.
Perinatal Factors ADHD
cerebral palsy, seizures, and CNS trauma or infections.
Postnatal Factors ADHD
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
