childhood impulse control Flashcards
disorders - Look for behavioral manifestations that
are not age appropriate
deviate from cultural norms in an UNHEALTHY way
Always involve families in the assessment and treatment as well.
Intellectual Development Disorders (IDD)
IQ < 70 w/ resulting impairment in function; age of onset < 18 yo
mild IDD - and what level of reading and writing
IQ 50-70 (85% of all persons w/ MR) - usually pretty high functioning, most need a little support, can live on their own sometimes. maximum expectation is reading and writing at 6th grade level
moderate IDD - expected reading and writing level
IQ 35-50 - maximum expectation is reading and writing at 2nd grade level
severe IDD - IQ - and what about speech?
IQ 20-35 - lives in a group home, limited speech.3-4% of ppl with DD.
profound IDD
: IQ < 20 - usually secondary to neurological disorder, like cerebral palsy. total care.
IDD - causes
genetic, medical and/or environmental factors, birth injuries - cord wrapped around neck, lead poisoning, mold, mercury
IDD - comorbities
Common comorbid dxs: ADHD, Mood D/O, ASD (autism spectrum disorder), Szs, Motor pxs
tx for IDD - what type of therapy (think of children)
Assess strengths to encourage independence
Use behavior modification
Referrals to community resources (e.g. JPC = Pomeroy center)
Autism Spectrum Disorder (ASD) - what age?
sxs usually appear early (as an infant) usually diagnosed between 1 1/2 and 3 yrs old. can appear as early as 6-8 weeks old - eye movements
multiple theories on etiology of ASD
autism now affects
1 in every 36 children in the US (1 in 23 boys) and the incidence is growing (in 2000, the rate was 1 in every 150 kids). The older a man is, the more likely the child will be autistic.
autism - developmental deficits in social skills and language***
difficulty reading other peoples’ faces
sing song voice, movie quotes over and over again
poor non-verbal and verbal communication
autism - over half
have some degree of IDD (IQ<70)
autism - males vs. females
males 4X> than females, but females have historically been underdiagnosed
autism interventions - what is the therapy called? (aba teaches autism)
early intevention is crucial. Applied Behavior Analysis (ABA)– behavioral therapy to teach communication skills, improve social interaction - give a star or sticker if they respond appropriately.
autism - diet
diet and complementary therapies are controversial; mixed results - inflammatory foods. corn, gluten, soy. might result in symptom reduction, but not cure. autism have higher heavy metals in system - so chelation may be used but can be very dangerous.
regressive autism
at 1 or 2, they stop functioning suddenly. these kids usually respond to alternative interventions.
meds for autism (zach is crazy)
no cure available, but Abilify and Risperdal have been FDA-approved for tx of tantrums, aggression, SIB; SSRIs for depression and anxiety sxs
autism prognosis
generally poor prognosis (better w/ higher IQ/language skills)
Attention Deficit Hyperactivity Disorder (ADHD)
characterized by poor attention span, distractibility, hyperactivity and impulsivity. the daydreamer, not absorbing material, disorganized, careless mistakes on homework. they can hyper focus on something they’re really interested in though.
ADHD - hyperactive symptoms - sleep?
interrupting, risk for injury nanda, ppl w/ adhd usually sleep well.
ADHD - causes - what about birth weight
genetics, brain injury, lead exposure, alcohol and tobacco use during pregnancy, low birth weight, premature delivery
autism - boys vs. girls
males 4X> than females, but females have historically been underdiagnosed
ADHD meds (Dex has ADHD)
ppl w/ ADHD are dopamine seeking*
CNS stimulants e.g. Ritalin (methylphenidate**), Dexedrine, Adderall
ADHD meds cont
atomoxetine (Strattera) - a norepinephrine reuptake inhibitor: less chance for abuse
ADHD meds cont (antidepressants)
Antidepressants e.g. SSRIs, buproprion (increases dopamine and norepinephrine)
ADHD meds cont
Alpha agonists e.g. clonidine and guanfacine (for aggression, impulsivity, hyperactivity)
nursing action - ADHD
Establish clear limits, regular routine - they need external structure
Decrease stimuli (2/2 difficulty “filtering out” extraneous stimuli) OR use of music can help some kids focus
Behavior modification
Protect from injury (2/2 impulsivity, risk-taking bx)
Oppositional Defiant Disorder (ODD)
just a difficult kid. can develop into conduct disorder. low serotonin.
ODD characteristics
disobedience, argumentativeness, angry outbursts, poor frustration tolerance, tendency to blame others rather than take responsibility for actions
ODD - high comorbidity w/
ADHD, learning disabilities, mood d/os and PSA
ODD - risk factors (odd was neglected)
harsh, inconsistent or neglectful parenting
parental conflict, divorce
parents w/ PSA, Mood d/o; Personality d/o
early institutional living (e.g. group home)
need structure, limits
Conduct Disorder (CD) - what neurotransmitter is low?
low serotonin
CD - characteristics (conduct your substance abuse)
serious violation of societal norms (e.g. aggression towards people and/or animals, destruction of property) fires. substance use, prostitution.
CD- most frequently diagnosed d/o among
most frequently diagnosed d/o among child/adolescent inpatient psych units
similar to ODD, but more dangerous
main difference is clear lack of empathy or remorse (precursor to Antisocial Personality D/O)
CD - interventions (also ODD) - and what type of groups are good?
protect others from client’s aggression (intervene prophylactically!)
teach/role-model social skills, anger mgmt
tx comorbid disorders (e.g. referrals for learning disabilities)
assist client to take responsibility for his/her behavior – peer confrontation groups are helpful
birth control, STD screen/tx, drug tests prn
Intermittent Explosive Disorder (IED)
don’t need to know much about this
impulsive, emotional outbursts and aggressive/violent behavior, but different from CD because these kids feel remorseful afterward
Separation Anxiety Disorder
inappropriate and excessive anxiety about being away from home or primary attachment figure (often leads to school phobia)
Reactive Attachment Disorder of Infancy and Early Childhood - 2 types (react to abuse)
result of gross pathologic care, repeated caregiver changes, abuse, neglect, incest.
two types: inhibited (they can’t get close to anyone) and disinhibited (they love everyone)
Tourette’s Disorder (a motor disorder
strong genetic component; males 2X > females
motor and vocal tics (e.g. blinking, coprolalia (curse words) (<10%), squatting) vocal tic - throat clearing, grunting
low self-esteem often develops 2/2 ridicule from other kids
interventions for all
Family Therapy
Group Therapy
Milieu Therapy
Behavioral Therapy
Cognitive Behavioral Therapy
Quiet Room
Time Out
Play Therapy - kids less than 12 yrs old
Mutual Storytelling
Therapeutic Games
Bibliotherapy
Therapeutic Drawing
Psychopharmacology
Enuresis - what age is not normal?
repeated voiding of urine into the bed or clothes -not normal past age of 4.
Encopresis (pres)
repeated passing of feces into inappropriate places (e.g. bed or the corner of the room)
elimination disorders - causes
Constipation is a major cause of both enuresis and encopresis. Assess and treat for this first!
what nanda for CD (CDs are defensive)
defensive coping
separation anxiety disorder - treatment
use desensitization, CBT
strong genetic component (e.g. parents with panic d/o)
autism - speech
stereotyped and repetitive use of language
inflexible adherence to routine
stereotyped or repetitive motor mannerisms (e.g.spinning) picky eaters, might wear sunglasses. spinners are hyporespontsive to vestibular.
autism - flexibility
intolerance for environmental changes (e.g. bed moved)
impairment in forming peer relationships - can’t go from parallel play (w/ other kids) to imaginary interactive play. usually around age 2 or 3.
sensory integration issues
elimination disorders - treatment (elimination bell)
Behavioral therapy (e.g. bell and pad technique) can be helpful for enuresis
Assess for stressors, esp with encopresis. Therapy can be helpful.
ASD
autism spectrum disorder
ADHD - age of onset
7 yrs old
copralalia
tourette’s - curse words
