childhood and neurodevelopmental disorders

Question 1

risk factors

Answer 1

biological: genetic and neurobiological
cognitive: temperament and resilience
environmental: ACES
cultural: ethnicity, worldview, religiosity, socioeconomics

Question 2

general assessment–children

Answer 2

mental status exam
developmental assessment (milestones?)
learning to adapt to environment and bond with others

Question 3

Interventions for children

Answer 3

behavioral interventions
play therapy
bibliotherapy (books)
journaling
music therapy
family interventions
expressive arts therapy
teamwork and safety

Question 4

Interventions–disruptive behavior management

Answer 4

time-out
quiet room
seclusion and restraint

Question 5

treatment modalities

Answer 5

pharmacotherapy, multimodal approach, meds good to combine with these measures

Question 6

neurodevelopmental disorders

Answer 6

Communication disorders
Motor disorders
Tic disorders
Specific learning disorder
Intellectual disability

Question 7

application of the nursing process

Answer 7

Assessment Guidelines
Assess for delays
Assess for signs of potential neglect or abuse
Nursing Diagnoses
Outcomes identification
Implementation
Individualized
Evaluation

Question 8

Autism

Answer 8

deficits in:
Social-emotional reciprocity
Nonverbal communicative behaviors used for social interaction
Developing, maintaining, and understanding relationships

Restricted, repetitive patterns of behavior, interests, or activities

Question 9

Autism criterion

Answer 9

Symptoms must be present in the early developmental period
Symptoms together limit and impair everyday functioning
Not better explained by intellectual disability

Question 10

Treatment modalities for ASD
pharmacological

Answer 10

Pharmacotherapy
Used to improve relatedness and decrease anxiety, compulsive behaviors, or agitation
The FDA has approved the use of some antipsychotic drugs, such as risperidone (Risperdol) and aripripazole (Abilify), for treating irritability associated with ASD in children between certain ages.

Question 11

treatment modalities for ASD
psychosocial

Answer 11

Applied Behavior Analysis (ABA)
Encourages positive behaviors and discourages negative behaviors
Early Intensive Behavioral Intervention (EIBI)
Improves language and cognitive skills
Early Start Denver Model (ESDM)
One-to-one interactions, joint play, and activity routines with the adult and child

Question 12

ADHD

Answer 12

inappropriate degree of
inattention, impulsiveness, hyperactivity
w/o hyperactivity (ADD)

Question 13

Assessment for attention deficit disorder and ADHD

Answer 13

level of physical activity
hyperactivity
talkativeness
attention span
social skills, comorbidities
symptoms (must be present in at least 2 settings)

Question 14

pharmacotherapy for ADHD

Answer 14

medications to increase task directed behavior
medications for aggressive behaviors

Methylphenidate (Ritalin or concerta) is approved for treating ADHD in children. It blocks the reuptake of two neurotransmitters, norepinephrine (NE) and dopamine, in presynaptic neurons.
Available orally or as transdermal patch

Ritalin is short acting, Concerta is long acting
Foaclin is more potent but has the same effects

must be at least 6 years or older before starting ADHD meds

Question 15

Ritalin and concerta contraindications and side effects

Answer 15

side effects: insomnia and nervousness
Growth retardation (decreased height, weight, and bone marrow density) when taken long term
(dizziness, headache, tics, restlessness/akathisia), gastrointestinal (nausea/vomiting, dry mouth, decreased appetite, weight loss, abdominal pain), and cardiovascular systems (tachycardia, and palpitations).
Methylphenidate can inhibit the metabolism of warfarin, phenytoin, tricyclic antidepressants, or SSRIs and can increase plasma concentration

glaucoma, severe hypertension, motor tics, Tourette syndrome, or a family history of Tourette syndrome.

monitoring for normal growth while kid is on these medications

Question 16

Amphetamines for ADHD

Answer 16

Amphetamine is FDA-approved for the treatment of attention-deficit/hyperactivity disorder (ADHD) central nervous (CNS) system stimulant that functions by increasing the amounts of dopamine, norepinephrine, and serotonin (to a lesser extent) in the synaptic cleft through a variety of mechanisms

Example meds include: Lisdexamfetamine (Vyvanse), amphetamine/dextroamphetamine( Adderall),

Dextroamphetamine (Dexedrine)is the only amphetamine medication FDA-approved for use in children younger than six years

Available as: immediate-release tablets, extended-release capsules, and an oral solution.

Question 17

amphetamines: adverse effects

Answer 17

Adverse Effects
slowing growth velocity and reduction in adult height in patients who took stimulants as children, with an average adult height deficit of 4.7 cm among patients who consistently took the medication
use of amphetamine with other serotonergic agents and/or CYP2D6 inhibitors (including fluoxetine, paroxetine, and bupropion) can increase the risk of serotonin syndrome.
insomnia, headache, dry mouth, tachycardia, increase in systolic blood pressure, restlessness, and irritability.

Question 18

contraindications for amphetamines

Answer 18

contraindicated during or within 14 days of MAOI therapy, e.g., phenelzine, due to the risk of hypertensive crisis.
Additional contraindications include symptomatic cardiovascular disease, advanced arteriosclerosis, glaucoma, hyperthyroidism, severe hypertension, agitated states, and a history of drug misuse.

MONITOR
Cardiac status
Management of amphetamine intoxication generally involves the use of benzodiazepines and antipsychotics to control agitation and psychotic symptoms. Beta-blockers can also help to control hypertension and tachycardia

Question 19

other childhood disorders

Answer 19

oppositional defiant disorder (ODD) where the kid consistently does not listen to authority and rebels

conduct disorder (CD)
can be a sentinel for antisocial personality disorder in adulthood
kids engage in risky and criminal behaviors

depression
more often in adolescent girls

Question 20

Treatment for depression in adolescents

Answer 20

Treatment
Antidepressants that are most commonly used in this age group are fluoxetine, sertraline, citalopram, and escitalopram.Fluoxetine andescitalopram are approved by the FDA for adolescent depression. Venlafaxine, a serotonin-norepinephrine repute inhibitor(SNRI), is a second-line drug due to its side effects.
Monitor
Suicidal thoughts