Cognition in Kids Flashcards
How do mental disorders impact on childhood development?
● Mental health disorders disrupt academic, social, and psychological functioning.
● Symptoms can cause distress in family dynamics and may lead to stigma, which
deters seeking help.
● Younger children are harder to diagnose due to limited language and emotional
development.
what are the Barriers to Early Intervention?
- Lack of consensus on screening.
- Coordination issues between care systems.
- Limited community resources and long waiting lists.
- Shortage of mental health providers.
- High costs and inadequate insurance reimbursement.
what are genetic and neurobiological risk factors?
- Genetic Factors:
○ Hereditary factors contribute to many childhood-onset psychiatric disorders.
○ Protective factors: resilience, intelligence, and a supportive environment help
limit mental disorders in genetically vulnerable children. - Neurobiological Factors:
○ Brain changes in childhood: declining synapses after age 5, changing brain
region volumes, and hormonal interactions.
○ Myelination improves speed and conduction of nerve impulses, aiding faster
reactions.
○ Frontal and prefrontal cortex changes during adolescence improve executive
functions (e.g., planning, organization, impulse control).
○ Adolescence is marked by low emotional regulation and behavioral fluctuations,
which stabilize over time.
what are cognitive risk factors?
- Temperament:
○ Temperament: A child’s overall mood and behavior in coping with environmental
demands.
○ Parent-child temperament fit: A mismatch may lead to insecure attachment
and risk for developmental or mental health problems.
○ Certain traits (e.g., shyness, aggression) may increase the risk for future issues,
such as substance use. - Resilience:
○ Resilience is the ability to recover from difficulties.
○ Factors promoting resilience include adaptability, nurturing relationships,
social intelligence, problem-solving skills, and long-term goals.
○ Resilient children can distance themselves from emotional chaos and form
meaningful relationships with supportive adults.
what are the environmental risk factors?
- Adverse Childhood Experiences (ACEs):
○ Trauma and abuse during childhood (e.g., emotional, physical, sexual) are
linked to adult dysfunction.
○ The CDC-Kaiser ACE study (1998) found that as ACEs increase, risks for
mental and physical health problems also rise, including ■ Substance abuse, depression, cardiac issues, fetal death, poor work
performance, intimate partner violence, and suicide. - Child Abuse:
○ Neglect is the most common form of child abuse in the U.S. (75% of cases).
○ Sexual abuse: Girls are more frequently victims, but boys are also affected, with
underreporting due to stigma.
○ All healthcare providers must report suspected child abuse to child protective
services. - Witnessing Violence:
○ Exposure to violence increases the risk of mental health problems and may
lead to aggressive behaviors or dysfunctional relationships later in life.
what are cultural risk factors?
● Differences in cultural expectations, stressors, and lack of support may profoundly
affect children and adolescents from diverse backgrounds.
● Nurses should be aware of their own biases and consider factors such as ethnicity,
gender, religiosity, and socioeconomic status when planning care
why are assessments and interventions important?
● Early assessment and intervention are crucial to prevent the long-term consequences
of childhood psychiatric disorders.
● Delayed interventions due to a “wait-and-see” approach can exacerbate the impact on
development and family dynamics.
what type of general assessments are needed to preform and gather?
General Assessment Topics
● Data Collected:
○ History of present illness, medical history, developmental history, family history.
○ Mental status and neurological development.
● Methods:
○ Interviews, screening, testing (neurological, psychological, intelligence), and
interaction with the child.
○ Multiple sources of data: parents, teachers, caregivers, structured
questionnaires, and behavior checklists.
○ Family diagrams (genograms) to show family relationships.
Initial Interview
● Goal: Build trust and observe interactions between the child, caregiver, and siblings.
● Process:
○ Semi-structured interview asking about home and school environment, family,
peers, and current problems.
○ Younger children may use therapeutic games, drawings, or puppets to
communicate.
how would you conduct a mental status exam on peds?
● Similar to adults, but adjusted for the child’s developmental stage.
● Categories Assessed:
○ Safety, appearance, socialization, activity, speech, coordination, affect,
intellectual function, thought processes, and play behavior.
what are developmental assessment?
● Purpose: Evaluate a child’s maturational level against expected milestones.
● Milestones: Walking, talking, toilet training.
● Tools: ○ Denver II Developmental Screening Test: 125 items across social/personal,
fine motor, language, and gross motor areas.
where can general interventions for PEDS be conducted? and what modalities does it include?
● Applicable in various settings (inpatient, outpatient, school outreach, home visits).
● Modalities Include:
○ Activities of daily living, learning, play, recreational activities, and peer/adult
interactions.
what are specific interventions for PEDS?
Behavioral Interventions
● Goal: Reward desired behaviors and reduce maladaptive behaviors.
● Example: Point system for rewarding age-appropriate behaviors.
Play Therapy
● Purpose: Allows children to express feelings and work through memories via play.
● Trauma Release: Helps move memories from nonverbal brain regions to verbal frontal
lobes.
Bibliotherapy
● Uses literature to help children express feelings and cope.
● Considerations: Cognitive development and emotional readiness are important when
selecting materials.
Expressive Arts Therapy
● Art mediums: Drawing, painting, sculpting to express nonverbal emotions, especially
after trauma.
Journaling
● Effective for teenagers, allows recording of emotions and progress, and helps start
dialogues.
Music Therapy
● Evidence-based: Improves physical, psychological, cognitive, and social functioning
Family Interventions
● Family counseling: Improves functional capacity and helps achieve goals.
● Group education: Useful for problem-solving, learning new information, and sharing
experiences.
why is teamwork and safety important?
● Multidisciplinary teamwork is essential, especially for neurodevelopmental disorders.
● Nurses lead the planning and implementation of safe and effective care.
● Goals: Promote safety, security, and personal growth while managing problematic
behaviors.
How do you manage disruptive behavior management?
Least Restrictive Intervention Principle
● Less restrictive methods are tried first (e.g., discussion, offering medication,
suggesting time-outs).
● Seclusion or restraint: Only considered when less restrictive interventions fail.
Time-Out
● Promotes self-reflection and control.
● Less restrictive than seclusion or restraint, involves designated quiet time.
Quiet Room
● Purpose: Reduce stimulation to help regain self-control.
● Types: Feelings room (for punching/throwing soft objects) and sensory room (for
relaxation and meditation).
How would you include the use of seclusion and restraint?
● Psychologically harmful and can be physically dangerous.
● Criteria: Only used when behavior is destructive or dangerous.
● Process:
○ Requires authorization by a physician or nurse practitioner.
○ Family is notified of any seclusion or restraint
○ Continuous monitoring: vital signs, hydration, elimination, comfort, psychological
and physical needs.
● Debriefing:
○ Post-incident discussion for both patient and staff to improve future management
and prevent recurrence.
what type of treatment is used for psychiatric disorders in young people?
Biological Treatments
● Pharmacotherapy: Psychiatric treatment often requires a multimodal approach,
combining medications and psychological treatments. Medications target specific
symptoms, improving quality of life and growth potential.
2. Psychological Therapies
● Cognitive-Behavioral Therapy (CBT):
○ Evidence-based for various psychiatric diagnoses.
○ Based on the principle that negative, self-defeating thoughts lead to
psychiatric problems.
○ Goal: Replace these thoughts with realistic, accurate appraisals to improve
functioning.
● Group Therapy:
○ Registered nurses can lead education and task groups focused on teaching
new skills, medications, and diagnoses.
○ Advanced practice nurses conduct formal group therapy for specific issues like
bereavement or chronic illnesses.
○ Children’s Therapy: Uses play to work through issues, improving impulse
control and social skills.
○ Adolescents’ Therapy: Involves peer relationships, identifying emotions, and
problem-solving through discussions, often using media events as a basis.
describe what it is, types, treatment: Communication Disorders and its types- Language disorder,speech sound disorder, childhood onset fluency disorder, social pragmatic communication disorder
● Affect language, speech, and communication, impacting academic achievement,
socialization, and self-care.
● Types:
1. Language Disorder: Difficulty using language (expressive or receptive).
■ Causes: Hearing loss, neurological disorders, intellectual
disabilities, and more.
2. Speech Sound Disorder: Difficulty making sounds, affecting articulation.
3. Childhood-Onset Fluency Disorder (Stuttering): Repetitions, hesitations
affecting communication.
4. Social (Pragmatic) Communication Disorder: Challenges with verbal and
nonverbal communication, requiring autism spectrum disorder to be ruled out.
● Treatment: Speech and language therapy, early intervention services, and special
education.
describe types and medications: Motor Disorders- developmental coordination disorder, stereotypic movement disorder, Tic disorder
● Developmental Coordination Disorder:
○ Impairments in motor skill development (e.g., difficulty tying shoes).
○ Treatment: Physical therapy and occupational therapy.
● Stereotypic Movement Disorder:
○ Repetitive purposeless movements (e.g., hand-waving, head banging).
○ Treatment: Behavioral therapy and naltrexone to reduce repetitive behaviors.
● Tic Disorders:
○ Motor and vocal tics, nonrhythmic and rapid.
○ Types:
■ Provisional Tic Disorder: Tics lasting less than 1 year.
■ Persistent Motor or Vocal Tic Disorder: Tics lasting over 1 year.
■ Tourette’s Disorder: Multiple motor and at least one vocal tic for more
than 1 year.
○ Medications:
■ Antipsychotics: Haloperidol, Pimozide, Aripiprazole, and
Risperidone.
■ Alpha 2-Adrenergic Agonists: Guanfacine and Clonidine.
■ Antianxiety Drug: Clonazepam.
■ Botulinum Toxin Type A (Botox) for muscle relaxation.
■ Deep Brain Stimulation (DBS) for severe cases.
describe the definition, diagnosis, importance of screening, support, long term outcomes: Specific Learning Disorder
● Definition:
○ Diagnosed when a child has persistent difficulty in reading (dyslexia),
mathematics (dyscalculia), and/or written expression (dysgraphia).
○ The child’s performance is well below the expected level for their peers.
● Diagnosis:
○ Made through multiple assessments, including formal psychological
evaluations.
● Importance of Screening:
○ Early screening for learning disorders is essential to provide crucial early
interventions.
● Assistance and Support:
○ Children with learning disorders are eligible for support through the Disabilities
Education Improvement Act.
○ Individualized Education Programs (IEPs):
■ Tailored treatment plans.
■ Careful monitoring of progress.
■ Special education interventions.
● Prevalence:
○ 1 in 5 children face a learning disability (National Center for Learning Disorders,
2017).
○ Higher risk: Children with lower family education, those in poverty, and
males.
● Long-term Outcomes:
○ Increased postsecondary education enrollment over the past 15 years.
○ Without interventions: Risks include low self-esteem, poor social skills, higher
dropout rates, difficulties with employment, and social adjustment issues.
describe the definition, onset, causes: Intellectual Disability
● Definition:
1. Characterized by deficits in three areas:
■ Intellectual Functioning:
■ Deficits in reasoning, problem solving, planning, judgment,
abstract thinking, and academic ability.
■ Social Functioning:
■ Impairments in communication, language, interpreting social
cues, and regulating emotions.
■ Daily Functioning:
■ Age-appropriate activities, self-care, and functioning at school
or work are impacted.
● Onset:
1. Begins during childhood development, ranging from mild to severe.
2. Involves the level of dependence on others for ongoing care and support.
● Prevalence:
1. Estimated to affect about 1% of the population (APA, 2013).
● Causes (Etiology):
1. Hereditary Factors:
■ Chromosomal disorders (e.g., Fragile X, Down syndrome, Klinefelter’s
syndrome).
■ Inborn errors of metabolism (e.g., phenylketonuria).
■ Other genetic abnormalities.
2. Pregnancy or Perinatal Issues:
■ Malnutrition, chronic maternal substance abuse, maternal infections.
■ Pregnancy complications: Toxemia, placenta previa, trauma during
birth.
3. Environmental or Social Factors:
■ Up to 20% of cases linked to social neglect (lack of nurturing
relationship, limited social or linguistic skill development).
4. Medical Conditions:
■ May also be associated with other mental disorders, like autism
spectrum disorder.
what are the assessment guidelines for intellectual disability?
● 1. Assess Developmental Delays:
○ Look for delays in cognitive and physical development or the inability to
perform tasks or achieve milestones compared to peers.
○ Gather information from family, caregivers, or those involved in the child’s life.
● 2. Assess for Delays in Functioning:
○ Evaluate cognitive, social, and personal functioning with a focus on the child’s
strengths and abilities.
● 3. Assess Independent Functioning:
○ Identify areas where the child can function independently and where support or
assistance is needed (e.g., hygiene, dressing, or feeding).
● 4. Assess for Signs of Abuse/Neglect:
○ Be vigilant for physical and emotional signs of neglect or abuse, as children
with behavioral and developmental issues are at higher risk for abuse.
● 5. Assess for Community Resources:
○ Determine the need for community resources or programs that can support
both the child’s intellectual and social development and the family’s need for
education and emotional support
what are nursing diagnosis and problems that may arise from Intellectual disability?
- theres issues in conception, social, and practical function and can be mild-severe
- kids have issues with: communicaiton, meeting self care, meeting safety, socializing
- family is stressed from always watching child
what are goals for both the patient and the family dealing with intellectual disability?
- speaking to respond and ask for things
- enagages in socialization
- accepts help and feedback
- stops impulses
- family accepts impairment
what implementation is required for those with intellectual disability?
- nurses service all types of settings
- IDEA mandates schools to provide services to help them be in school
- individual care plans
- long term focuses on needs as they enter adulthood
How do we know that the treatment was successful in someone with intellectual disability?
● Nurses should use a strength-based perspective to evaluate both the child and the
family.
● Evaluation focuses on:
○ Identifying areas of need and capabilities.
○ Maximizing family resources.
○ Linking families to timely and efficient services.
○ Ensuring care is patient- and family-centered.
● Family Support:
○ Families may need continuous education and reinforcement to maintain
realistic expectations for the child.
● Lifelong Support:
○ Families and children with intellectual disabilities will require lifelong support.
● Long-term Planning:
○ Goals should include transitioning the child to a level of supervised or
assisted care as they age into adulthood.
what is the severity and definition of ASD?
● Definition: ASD is a complex neurobiological and developmental disorder that typically
manifests in the first 3 years of life. It affects social interaction and communication skills.
● Severity: ASD ranges from mild to moderate to severe, impacting individuals in varying
degrees.
what are the symptoms of ASD?
● Social Deficits: Problems with social relatedness, including difficulty in developing and
maintaining relationships.
● Communication Issues: May involve repetitive speech patterns and difficulties in verbal
and non-verbal communication.
● Behavioral Patterns:
○ Repetitive behaviors (e.g., stereotypical speech).
○ Obsessive focus on specific objects or routines.
○ Hyperreactivity or hyporeactivity to sensory stimuli.
○ Resistance to change in routine or environment.
● Onset: Symptoms typically appear in childhood and cause daily functional impairments.
● Variability: Some individuals may have normal or exceptional abilities in specific areas,
like music or mathematics (Savant syndrome).
what are genetic and demo factors in ASD?
● Genetics: High genetic correlation; concordance rates in identical twins range from 70%
to 90%.
● Gender: ASD is four times more common in boys than in girls.
● No Boundaries: ASD affects people across all races, ethnicities, and social
backgrounds.
why are early interventions and development important in ASD?
. Early Intervention and Development
● Importance of Early Intervention: Timely interventions improve long-term outcomes for
children with ASD, but many families may not have access.
● Developmental Patterns:
○ Early signs may include lack of interest in social interactions and poor eye
contact.
○ Development may stabilize or worsen during puberty.
what are the assessment guidelines for ASD?
- Developmental History: Look for developmental delays or loss of previously acquired
abilities. - Communication: Evaluate both verbal and non-verbal communication, and observe any
aggressive or self-injurious behaviors - Parent-Child Relationship: Assess bonding, anxiety, and temperament fit between
parents and child. - Abuse Risk: Children with developmental issues are at increased risk of abuse; assess
for any signs. - Comorbidities: Ensure screening for intellectual disabilities or other comorbid
conditions. - Community Support: Evaluate the family’s need for community-based programs,
including education and counseling services.
what are the nursing diagnosis for ASD?
● ASD presents with significant social and communication impairments, often alongside
intellectual disabilities (IQ <85).
● Family stress is high due to the chronic nature of ASD, particularly regarding bonding
and behavioral issues (e.g., head-banging).
What are goals for ASD?
● Social Skills: Goals include cooperating with others, showing consideration, and
improving sensitivity to social cues.
● Communication Skills: Goals include accurately interpreting and exchanging
messages.
● Family Outcomes: Focus on adapting to the challenges of ASD and accessing
community support services.
what implementations for ASD?
● Referral to Early Intervention: Children with ASD should be referred to early
intervention programs to enhance development.
● Behavior Management: Utilize reward systems, provide structure and consistency at
home, and offer behavior-modifying therapies.
● Family-Centered Care: Tailor care plans to the family’s goals and strengths, with
ongoing support from a multidisciplinary team.
● Therapeutic Programs: Treatment may include therapeutic nursery schools, day
programs, and special education.
how do we know that the treatment for ASD was successful?
● DSM-5 Levels of Support:
○ Level 1: Requires support.
○ Level 2: Requires substantial support.
○ Level 3: Requires very substantial support.
● Outcomes for Different Levels: Children with milder forms may participate more
actively in social activities, while those with more severe impairments (nonverbal,
needing daily living support) will rely heavily on family support
● Monitoring Stress: Ongoing evaluation of family stress is crucial to ensure they are
utilizing available resources and services.
what medications are used for ASD?
Biological Treatments
● Medications:
○ FDA-Approved Antipsychotics: Risperidone (Risperdal) and aripiprazole
(Abilify) are used for treating agitation in children with ASD. These reduce
irritability, tantrums, and aggression.
○ Selective Serotonin Reuptake Inhibitors (SSRIs): May be prescribed off-label
to reduce anxiety and improve mood.
○ Stimulants: Help manage hyperactivity, impulsivity, or inattention.
○ Naltrexone: Sometimes used off-label to reduce repetitive and self-injurious
behaviors.
what therapies are used for ASD?
● Applied Behavior Analysis (ABA): Encourages positive behavior and discourages
negative behavior, with progress being carefully tracked.
● Early Intensive Behavioral Intervention (EIBI): A long-term and intensive therapy (up
to 40 hours per week) that improves language and cognitive skills using reinforcement
techniques.
● Early Start Denver Model (ESDM): Focuses on one-on-one interactions between adult
and child, using everyday activities as learning opportunities.
What is ADHD?
● ADHD is characterized by inappropriate levels of inattention, impulsivity, and
hyperactivity.
● Primarily Inattentive Type: Those who show inattention without hyperactivity.
● To diagnose ADHD, symptoms must:
○ Appear in two or more settings (e.g., home and school).
○ Begin before age 12.
what are the Risk factors for ADHD?
● ADHD affects about 10% of children/adolescents between ages 5-17.
● ADHD is more common in boys (14%) than girls (6%).
● Children in poor health are more likely to have ADHD.
● ADHD often co-occurs with other disorders, including:
○ Oppositional Defiant Disorder
○ Conduct Disorder
○ Anxiety and Depression
what are the symptoms for ADHD?
Inattention Symptoms:
● High distractibility, difficulty organizing tasks, and failure to complete them.
● Forgetfulness and frequent loss of things.
Hyperactivity and Impulsivity:
● Excessive movement, talking, and trouble sitting still.
● Difficulty waiting for turns, and interrupting others.
Emotional and Social Impacts:
● Struggles with peer relationships due to intrusive behaviors.
● Low self-esteem, poor school performance, and frequent frustration.
what are the assessment guidelines for ADHD?
- Collect data from parents, teachers, and caregivers about:
○ Physical activity levels, impulsivity, attention span, and frustration
tolerance. - Assess social skills, friendship history, and school performance
- Evaluate for comorbidities like anxiety, depression, and learning disabilities.
- Monitor sleep and eating patterns, especially for children on stimulant medication.
what are the nursing diagnosis for ADHD?
● Potential issues include:
○ Impaired social interactions.
○ Risk for injury due to impulsivity.
○ Low self-esteem and noncompliance with age-appropriate social norms.
what are the goals for ADHD?
● Key goals include:
○ Improved impulse control and social relationships.
○ Development of positive coping skills and self-esteem.
○ Better family functioning and peer interactions.
what are interventions and implementations for ADHD?
● Focus on:
○ Adaptive coping mechanisms and pro-social goals.
○ Engagement in therapy (individual, family, group) with a focus on parenting
skills.
○ Referral to specialized programs for long-term or intensive treatment.
○ Encourage family involvement in nurturing and consistent limit-setting.
Behavior Management Techniques:
● Behavior modification strategies like positive reinforcement.
● Environmental structuring to create routines and decrease distractions.
how do we know that the treatment for ADHD worked?
● Symptom evaluation will depend on ADHD type:
○ For inattentive type: assess academic performance, daily living skills, and
social relationships.
○ For hyperactive/impulsive type: focus on impulse control and behavioral
responses.
Family Evaluation:
● Assess family’s understanding of the disorder and their ability to manage symptoms.
● Ensure the family’s expectations are realistic and the child is progressing towards
independence.
● Long-term planning is key as ADHD persists into adulthood.
what medications are used for ADHD?
● Stimulant medications (e.g., Methylphenidate, Adderall) are first-line treatments.
○ Benefits: Improved attention, reduced impulsivity, and task-directed behavior.
○ Common side effects: Insomnia, appetite suppression, and lethargy.
○ Extended-release versions offer easier dosing and reduced side effects like
insomnia.
● Non-stimulant medications:
○ Atomoxetine (Strattera): Useful for patients with anxiety or substance use
disorders.
■ Side effects include gastrointestinal issues, dizziness, and insomnia.
■ Requires ongoing monitoring of vital signs and liver function.
● Alpha-2 adrenergic agonists: Clonidine and Guanfacine can reduce agitation and
increase frustration tolerance.
Medications for Aggression:
● Stimulants, mood stabilizers, and antipsychotics are used for aggressive behaviors.
● Mood stabilizers like Lithium and anticonvulsants help with impulsivity and mood
instability.
what are the therapies for ADHD?
● Behavior Therapy:
○ First-line treatment for children younger than 6.
○ Focuses on parent training to help manage the child’s behaviors.
● Cognitive Behavioral Therapy (CBT):
○ Aims to improve internal control, problem-solving, conflict resolution, and
social skills
