Child And Adolescent Disorders Flashcards
Autism spectrum disorders
Spectrum disorder
Severe autism - high functioning
Severe autism
May have trouble getting themselves dressed
High functioning autism
A high end fully verbal group
“Savants” excel in particular areas music, art memory math or perceptual skills such as puzzle building
ASD manifest at which ages
Early child hood / toddler years primarily 18-36 mo
Parent may start seeing things they notice is different
Why is autism increasing now
Increased awareness and better screening
Clinical manifestations of ASD demonstrate in
Social interaction
Communication
Behavior
Social differences in ASD
Doesn’t make eye contact or makes very little contact*
Doesn’t respond to a parents smile or other facial expression
Doesn’t look at objects a parent is looking at or pointing to
Doesnt point to objects to get a parent to look at them
Doesnt bring objects of interest to show a parent
Doesn’t have appropriate facial expressions *
Unable to perceive what others might be thinking or feeling by looking at their facial expressions
Does not show concern or empathy for others
Unable to make friends or uninterested in making friends
Communication impairments common sign in ASD?
Range from absent to delayed speech
May lose language or other social milestones (regression)
If someone comes in with delayed speech what is done next
Hearing and speech is avaluated if a delay or regression in noted
Echolalia
Repeats exactly what others say without understanding the meaning (parroting or echoing) immediate or delayed
Stereotypic behavior or stimming
Rocks ,spins away , twirls fingers, walks on toes for a long time or flaps hands
The behaviors often involve repetitive movements or sounds
What may someone with ASD be sensitive to?
Smells, sounds, lights, textures and touch
T o F
someone with ASD hardly has tantrums
False
They may have intense temper tantrums or show aggression
When is standardized screening done at?
At well visits
What gets screened at 9 mo
Developmental screening
Are they where they should be at 9 months
What is screened at 18 mo
Developmental and autism screening MCHAT
Screening for 24- 30 mo
Developmental and autism again MCHAT
MCHAT
Modified check list for autism in toddlers
Gold standard for diagnosing ASD
Autism diagnostic observation schedule (ADOS)
Purpose of behavior modification programs
We are trying to modify behaviors so we are trying to give positive rewards for positive behaviors
Applied behavior analysis (ABA)
Teach reinforces and maintains new skills and desirable behaviors
In
Communication
Social interactions
Reading& academics
Motor skills
Hygiene and grooming
What problematic behaviors can ABA help extinguish?
Self injury like banging head on wall
and aggression toward others
What kind of problems do we run into with ABA
Intensive therapy and it requires a minimum of 25 hours a wk for it to work so time wise is hard on parents who have to work
Also expensive
If someone w autism is diagnosed and we refer them to local state dept of mental health and developmental disabilities - why is this?
Because they have access to social workers and resources that will be helpful for them
They can be able to access programs that they qualify for
early childhood intervention (ECI)
Birth to 3 years
We refer to this program as soon as autism is SUSPECTED
If caught during this time frame for autism the child can have home visits, PT, OT , speech therapy
Individualized education programs (IEP)
Pre school program (3-5 yrs) autism
What do they need to be successful in school?
Special education
5-21 yrs
Into regular school IEP
Here is what they need to be successful
Hippotherapy
Therapeutic horseback riding
Hippotherapy
Complimentary therapies /alternative medicine
Therapeutic horseback riding
Strategy used by PT, OT and speech pathologist
Diet/supplements for ASD ?
Gluten free*
Casein-free diets (protein present in dairy) *
Vitamin and omega 3 supplementation
High fat and low carb diet (keto)
Anti-psychotic meds for ASD and what is it used for
Resperidone (risperdal)
Apripazole (abilifly)
Aggressive behavior
Deliberate self injury
Temper tantrums
What is used in sleep issues for ASD?
Melatonin along with a weighted blanket
As far as nursing care, how can we decrease stimulation for someone with ASD?
Private room , avoid extraneous auditory and visual distractions
Nursing care for an autistic child
Decrease stimulation
Minimal holding touch and eye contact
Organize care so we are not in there all the time
ADHD
Inattention
Impulsiveness
Hyperactivity
How long does some one experiencing ADHD symptoms have to be experiencing them before diagnosed
6 months
Have to be careful when diagnosing because it can be developmental instead of ADHD
At how many settings and what settings are symptoms of ADHD that must be present to get a confirmed diagnosis
In 2 or more settings
At school (academic)
At home
Social setting
3 sub types of ADHD
*Combined type (most common)
*Predominantly inattentive
* Predominantly hyperactive impulsive type
Diagnostic - Maladaptive with ADHD
Is it causing some kind of problem in ther life
(Stops them form adapting to new or difficult situations ) and inconsistent w their developmental age
Two diagnostic test for adhd
Psychological testing
Behavioral check list
Psychological testing
ADHD
Projective testing and IQ & achievement levels
Behavioral checklist
For ADHD
Parents and teachers can fill out
Do you see this behavior and how often?
Multimodal treatment
For adhd
Pharmacotherapy
Behavioral intervention
ADHD coaching
ADHD coaching
Teaches the individuals to manage their inattention, hyperactivity and impulsivity by by developing self awareness and strategies
What is medication determined by for adhd
Age
Usually wait till 5 years and older to give medications
Psychostimulants
For adhd
Start small dose initially
Gradually increase till we get the desired response
Jornay PM
ADHD psychostimulant
Type of Ritalin extend and release
First and only medication dosed at night
Methylphenidate hydrochloride
ADHD
Ritalin
Most commonly used
Dextroamphetamine sulfate
Dexedrine
ADHD
Not commonly used
Lisdexamfetmine (Vyvanse)
ADHD
Psycho stimulant
If Ritalin is not working this is the next line drug
Dextroamphetamine -amphetamine (adder-all)
Psychostimulant
ADHD
Side effects of stimulant meds (adhd)
Loss of apetite (weight loss)
Abdominal pain (n&v)
Suppression of growth
Sleeplessness
Headaches
Crying and irritability
Cardiovascular stimulation (hypertension)
Atomoxetine ( strattera)
Non stimulant medication
Suicidal thoughts is side effect
Teach parents change in mood or signs of depression
Adjunct therapy
Selective adrenergic agonist
ADHD
Clonidine (catapres) extend and release
Meds for adjunct therapy
Tricyclic antidepressants
ADHD
Notriptyline( pamelor)
Imipramine( tofranil)
Desipramine( norpramin)
Side effect- increase in the incidence of dental caries
Adjunct therapy meds for adhd
Selective adrenergic agonist
Tricyclic antidepressant
Environment changes that can help with adhd
Organizational charts *
Families and teacher- same goal
High structured environment
Parents, school, pediatrician working together
Decrease distractions*
Show parents how to monitor positive behavior
What is important to teach about caffeine and stimulants ?
Caffeine decreases the efficacy of stimulant medications
What would we teach parents who’s child is having issues with weight loss due to side effect of stimulant adhd
Nutritious snacks in evening when effects of med is decreasing
Serve frequent small meals and healthy on the go snacks(cheese sticks fruits)
If child on a stimulant is having trouble sleeping what can we do to help?
Change the dosing
What are children with adhd AT RISK FOR
Increased risk for accidents and unintentional injuries due to impulsivity
And decrease judgement of dangerous activities
When is stimulant methylphenidate , dextroamphetamine medication used for ODD
Only used if they have ADHD too. Will not use alone for ODD.
When are antidepressant (fluoxetine, setraline)meds used in ODD?
When behavior management is only achieving lemonade, results and hostile and aggressive behaviors are on going
If ODD is untreated what can progress to
Conduct disorder . And if that isn’t handled it can turn to anti social or personality disorder
Hallmark signs of conduct disorder
Aggressive behavior
In conduct disorder what do they lack regarding aggressive actions to people or property
Remorse
What is the best treatment for conduct disorder
Prevention - catch at ODD
What medications are used for conduct disorder
Antipsychotics and mood stabilizers
Gender dysophoria diagnostic criteria in children
A noticeable in congruence between ones experienced / expressed gender and signed gender
At least 6 mo duration
Manifested by at least 6 of criterion
Diagnostics criteria for gender dysphoria
Is it causing distress in their life?
Biological sex
Assigned gender
Gender expression
What they identify as
Identity
Hormonal suppressors
Puberty blockers
Fully reversible
Give child more time to make. Dont know long term effects
Regular cross sex Hormone therapy
Longer they are on this the less reversible they are
As they develop secondary charecteristics can’t reverse
Meds for childhood depression
Tricyclic antidepressants
Selective serotonin reuptake inhibitors (SSRI)
SSRIs for depression
Fluxetine (Prozac)
Escitalopram (lexapro)
Sertaline (Zoloft)
With antidepressants how long does it take for them to work
2-4 weeks
Adverse effect of antidepressant
Increased suicidal thinking in pediatric pt (black box warning) teach parents to report change in behavior
Suicide risk assessment
Presence of suicide ideation
Specific plans for self injury
History of actual self harm or threats or gestures
Suicide
The deliberate act of self injury with the intent that ine injury results in death
Suicide ideation
Involves a preoccupation with thoughts about committing sucicide (may be a precursor to suicide)
Just thinking about
Suicide attempt
Attempted to accuse injury or death
With previous suicide attempts its important to know
They are at high risk for doing it again so monitor closely
Meds for conduct disorder
Antipsychotics, mood stabilizer
