childhood and neurodevelopmental disorders Flashcards
risk factors
biological: genetic and neurobiological
cognitive: temperament and resilience
environmental: ACES
cultural: ethnicity, worldview, religiosity, socioeconomics
general assessment–children
mental status exam
developmental assessment (milestones?)
learning to adapt to environment and bond with others
Interventions for children
behavioral interventions
play therapy
bibliotherapy (books)
journaling
music therapy
family interventions
expressive arts therapy
teamwork and safety
Interventions–disruptive behavior management
time-out
quiet room
seclusion and restraint
treatment modalities
pharmacotherapy, multimodal approach, meds good to combine with these measures
neurodevelopmental disorders
Communication disorders
Motor disorders
Tic disorders
Specific learning disorder
Intellectual disability
application of the nursing process
Assessment Guidelines
Assess for delays
Assess for signs of potential neglect or abuse
Nursing Diagnoses
Outcomes identification
Implementation
Individualized
Evaluation
Autism
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
Autism criterion
Symptoms must be present in the early developmental period
Symptoms together limit and impair everyday functioning
Not better explained by intellectual disability
Treatment modalities for ASD
pharmacological
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.
treatment modalities for ASD
psychosocial
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
ADHD
inappropriate degree of
inattention, impulsiveness, hyperactivity
w/o hyperactivity (ADD)
Assessment for attention deficit disorder and ADHD
level of physical activity
hyperactivity
talkativeness
attention span
social skills, comorbidities
symptoms (must be present in at least 2 settings)
pharmacotherapy for ADHD
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
Ritalin and concerta contraindications and side effects
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
Amphetamines for ADHD
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.
amphetamines: adverse effects
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.
contraindications for amphetamines
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
other childhood disorders
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
Treatment for depression in adolescents
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
