Children & Adolescents Flashcards
Autism Spectrum Disorder
usually onset 1st 3 years of life but not diagnosed until school
difficulties in verbal, nonverbal communications, social interactions, or play activities
engage in hyperactivity, aggression, head banging, temper tantrums, or unusual sensitivity to sensory stimuli
ASD predisposing Fx.
- Neuro (brain abnormalities or neurotransmitters)
- Physiological implications (certain medical condition -fragile X, maternal rubella, tuberous sclerosis)
- Genetics (family assoc., chromosomal involvement)
- perinatal influence (maternal asthma/ allergies)
Asperger’s disorder
Onset: preschool age
S/S: children show same problems with social interaction and restricted/repetitive behaviors in autism
-can have normal to mild intellectual disability
No delay in: language, cognitive dev., self-help/adaptive skills, and environment curiosity
Prognosis: Fair to poor (seizure d/o common)
Rett’s Disorder
Onset: Females only (2+ years old)
S/S: severe intellectual disability & assoc., with seizure d/o
-normal development 1st 5months of life, has a loss of previously acquired hand skills, and eventual stereotypic hand movements
-impaired language development
Outcome: poor
Childhood disintegrative d/o
Onset: M>F, 2-10 years old
S/S: period of normal development
-no head growth development or loss of hand skills
-does have loss of skills in expressive or receptive language, social skills, play, and bowel/bladder control
-impairments in social interactions, communication, and repetitive, restrictive behavior as autism
Outcome: Poor
ASD meds (risperidone)
5-16 years
dosage based on weight/clinical response
SEs -drowsy, increased appetite, nasal congestion, fatigue, constipation, drooling, dizzy, weight gain
ASD meds (aripiprazole -abilify)
6-17 years
started at 2mg/day, then increased by 5mg/day at intervals of at least a week
SEs: sedation, fatigue, weight gain, vomiting, somnolence, tremor
ASD meds (aripiprazole -Abilify)
6-17 years
started at 2mg/day, then increased by 5mg/day at intervals of at least a week
SEs: sedation, fatigue, weight gain, vomiting, somnolence, tremor
ADHD
onset -not until child reaches school (M>F)
S/S: child inattentive to environment, hyperactivity/impulsiveness, s/s must be inconsistent with child’s development and cause significant impairment in functioning
Outcome: manageable (stimulants & therapy)
-have to weigh/check height periodically to make sure developing appropriately
ADHD assessment
- difficulty in performing age-appropriate tasks
- highly distractible
- accident prone
- low frustration tolerance and temper outbursts
- boundless energy
ADHD assessment
- difficulty in performing age-appropriate tasks
- highly distractible
- accident prone
- low frustration tolerance and temper outbursts
- boundless energy
ADHD meds: amphetamine
stimulant
SEs -insomnia, restlessness, h/a, palpitations, tachycardia, anorexia/weight loss, mood up/down,
dependence/abuse possible
- take meds at least 6hr b/bedtime
- periodic drug holidays
- limit caffeine
- avoid OTC (can interact with med and be toxic to child)
ADHD meds: dextroamphetamine
longer duration of action & less expensive
ADHD meds: Methylphenidate (Ritalin, Concerta)
fewer SEs
ADHD meds (Atomoxetine -Strattera) an SNRI
Selective inhibits NE (non-stimulant)
SEs -palpitations, tachycardia, anorexia/weight loss, N/V/Constipation, SEVERE LIVER DAMAGE, new/worsened psych s/s
Keep consistent schedule
Bupropion (Wellbutrin) -atypical antidepressants and nonselective reuptake inhibitors
SEs: palpitations, tachycardia, anorexia/weight loss, N/V/C,
Increased risk of toxicity with MAOIs/heart issues with tricyclics
Contraindicated with eating d/o or seizure hx.
Tourette’s syndrome
Tics compulsive and irresistible. Worsened by stress. Lessened when person becomes absorbed in an activity
-motor tics (involve head, torso and upper/lower limbs)
starts with simple motor tics (eye blinking, neck jerking, shoulder shrugging) then onto complex motor tics (squatting, hopping, skipping, tapping, and retracing steps
- vocal tics (words/sounds like squeaks, grunts, barks, yelps, clicks, sniffs, snorts)
- complex vocal tics (repeating obscenities)
- repeating certain words/phrases not in context
- palilalia (repeating own words)
- echolalia (repeating other’s words)
Predisposing fx of Tourette’s
Biological -genetics -abnormalities in DA, GABA, NE, Ach -dysfunction in basal ganglia Environmental -pregnancy complications -low birth weight -head trauma -carbon monoxide poisoning -encephalitis
Tourette’s Meds
Typical antipsychotics
-haloperidol (not for <3yrs) & chlorpromazine
(can cause cognitive dulling, EPSEs)
Atypical antipsychotics
- risperidone and aripiprazole (Abilify)
- fewer SEs (does have weight gain)
- more effective in reducing s/s
Oppositional Defiant Disorder (ODD)
- recurrent and hostile pattern of behavior towards authority
- Comorbidities: ADHC, anxiety, & mood d/o
- begins by 8yr (usually not later than earlier adolescence)
ODD Sx.
stubborn
argumentative
limit testing
refusal to accept blame
deviant behavior with authority
sx. most evident at home
NO SERIOUS VIOLATIONS OF BASIC RIGHTS OF OTHERS
passive-aggressive behaviors (running away, school avoidance/underachievement)
don’t see themselves as oppositional but view the problem as being caused by others
ODD Rx.
need consistency
help take responsibility for own behavior
promote increased self-worth
Conduct Disorder (CD)
-repetitive, persistent pattern of behavior in which BASIC RIGHTS OF OTHERS and major age-appropriate societal norms/rules are VIOLATED
-SX. start 5-6 years
-Dx. behavior need to be s/s of a problem with the child (not d/t poverty, war, crime, fear)
-often children lack adequate parenting and family support - “functional orphans”
-use physical aggression in violation of others’ rights
-low self-esteem but “tough guy”
Can’t control anger
serious violation of rules/violates rights of others
Childhood-onset CD
males more
at least 1 sx b/age 10
more likely to get ODD and antisocial PD as an adult
Adolescent-onset CD
show no sx b/age 10 act out misconduct within peers school discipline issues Boys: fight, steal, vandalize girls: truant, run away, abuse substance, prostitution
Predisposing fx to CD
Biological (genetics, temper, NE & 5-HT)
Psychosocial (peer relationships)
Family (frequent shifting of parental figures, early institutional living, inconsistency, parental rejection)
CD Rx.
ensure safety
assisting in dev. of socially appropriate behaviors
encouraging client to accept responsibility
Managing Disruptive Behavior Techniques
-planned ignoring
-set limits
appeal to child’s developing self-control
-removed child from situation
-give early help if child easily frustrated
Separation Anxiety disorder
excessive anxiety concerning separation from home or attachment figures (won’t sleep away from home, worrying, won’t attend school w/o parent, “shadow” parent, nightmares or specific phobias
onset b/18 years (commonly at 5-6)
Cause: after a stressful life event/family (parental overprotection, separation conflicts between parent and child, possible over attachment to mother
PTSD in children
commonly assoc. with child abuse (rarely have flashbacks)
Preschool (relive trauma in play/drawing, loss of previously learned skills, nightmares/night terrors, irritable/angry/temper tantrums
School-aged children (irritable, can’t concentrate, hypervigilance, nightmares)
Attachment Disorders
Reactive Attachment Disorder (RAD) -major inhibition
-child rarely directs attachment behaviors toward any adult caregivers
Disinhibited social engagement disorder -exhibition
-no normal fear of strangers or unfazed by separation of parents
Feeding/Eating D/O
feeding d/o -child not getting enough food even though enough food is available and does not gain weight (failure to thrive)
Rumination d/o -repeated regurgitation and rechewing of food
-males 3-12 months
-lack of nausea, retching, of GI problems
-may have dev. issues
PICA
-persistent eating of non-food substances
-frequently assoc. with retardation
-no aversion to eating food
MDD
- show a depressed/sad mood/anhedonia in almost all activities at least 50% of time
- describe things as blue, bad, gloomy, empty
- self-critical
- feel unloved
- social withdrawal
- pervasive boredom
Dysthymia
- chronic disorder with periods of depressed affects interspersed with normal mood
- children more prone to have GREATER IRRITABILITY
- react negatively/shyly to praise
- low self-esteem/low energy
- inadequate/rejecting/chaotic home
