disorders of children/adolesscents Flashcards
assess development and functioning
- types of play
- social skills
- problem sloving skills
- energy level and motivation
- trauma , hospitalization, injuries affecting CNS
ASSESS CONCERNING BEHAVIORS
- behaviors/changes occur across a variety of settings
- changes in sleep or appetite
- social withdrawal
- regression
- frequently appears upset, sad or tearful
- self destructive behavior
- repeated thoughts of death
GENERAL COLLABORATION INTERVENTIONS
- play therapy
- family therapy
- school based interventions /educational plan
- family education
- medications
- structured mileu
COMMON CHILDHOOD BEHAVIORS
Neurodevelopmental disorders
- attention deficit /hyperactivity disorder
- autism
Disruptive, impulse control and conduct disorders
- oppositional defiant disorder
- conduct disorder
Trauma and stressor related disorders
-PTSD
Early onset disorders
ADHD OVERVIEW
- may have excessive motor activity as toddler
- most identified in elementary school
- more prevalent in boys
- co-morbidities common(tics, torets, anxiety,ODD,Depression)
- risk factors for difficulties in adulthood
ADHD symptoms
characterized into 3 groups
- hyperactivity
- impulsive behavior
- lack of attention
-symptoms present before age 12
-symptoms last more than 6 months
interfere with functioning or development
ADHD PATHO AND ETIOLOGY
- unclear
- neurotransmitter deficits
- delay in brain maturation
- genetic factors
- biologic factors
- environmental risk factors - lead exsposure, fetal infection
ADHD NON PHRAM THERAPY
ENVIRNMENTAL MODIFICATION
- decreasing stimulation
- calm environment
- classroom adjustments
- structured daily routine
BEHAVIORAL THERAPY
- rewards for desired behaviors
- consequences for problem behaviors
- point system
- established cues
- involve parents and teachers
ADHD PAHRM THERAPY
- mechanism of action on symptoms not well understood
STIMULANTS
- methylphenidate( ritlan)
- amphetamine- dextroamphetamine (Adderall)
- dexmethylphenidate (focalin)
- oral and patch formulations
side effects- headches, anorexia, insomnia
ADHD PHARM NON STIMULANTS
atomoxetine- selective norepinephrine inhibitors buproprion - antidepressant clonidine- adrenergic agent -aggressiveness -impulsivity - hyperactivitey
ADHD NURSING INTERVENTIONS
- administer medications
- minimize environmental distractions
- implement behavioral management plans
- provide education
- promote self esteem
- provide emotional support
AUTISM SPECTRUM DISORDER OVERVIEW
- 1 in every 88 births in the USA
- 5 times more common among boys than girls
- equal prevalence across cultural groups
- typically recognized in 2nd year of life
- symptoms range from mild to severe
AUTISM SYMPTOMS
IMPAIRMENT IN -communication - social interaction - adapting to new sitiuations attention span ability to organize responses to situations
REPETITIVE , RESTRICTIVE, STEREOTYPED BEHAVIORS
AUTISM PATHO AND ETIOLOGY
- unknown
- genetic
- immunological
- environmental
AUTISM NON PHARM THERAPY
- early intervention
- behavior management
- therapy- play, speech and language,PT and OT
Nutrition
- gluten free
- vitamins(A,C, B6,Omega 3)
- antacids
- detoxification
AUTISM PHARM THERAPY
-no medication indicated for autism
- medications manage associated symptoms
stimulants
SSRIs
mood stabilizers
AUTISM NURSING INTERVENTIONS
- prevent injury
- provide anticipatory guidance
- stabilize environmental stimuli
- provide supportive care
- enhance communication
- facilitate community based care
OPPOSITIONAL DEFIENT DISORDER OVERVIEW
- disobedient, hostile, defient behavior
- estimated 1-6% of children and adolescence
- typically appears in late prechool/early school age
- 1/4 do not continue to meet diagnostic criteria over next several years
OPPOSITIONAL DEFIENT DISORDER symptoms
- angry irritable mood
- argumentive/ defient behavior
- vindictiveness
- typically interfers with relationships and school performance
ODD RISK FACTORS
- genetic
- biological
- psychological factors- cant process social ques
- social /environmental factors
ODD TREATMENT
- parent management therapy
- family therapy
- cognitive problem solving skills training
- social skills programs
- medications foe coexisting conditions
ODD NURSING INTERVENTIONS
behavior management
- consistent rules
- address unacceptable behavior
- reinforce positive behavior
- consequences for negative behavior
- reinforce positive behavior
CONDUCT DISORDER OVERVIEW
- behaviors that violates rules and or rights of others
- often follows ODD but not always
- rare onset after 18 year
- symptoms often present before 10 years
CONDUCT DISORDER SYMPTOMS
- aggression to people and animals
- destruction tpo property
- deceitfulness, lying or stealing
- serious rule violation
CONDUCT DISORDER RISK FACTORS
environmatal
boliogical
genetic
co morbidities -mood disorders -subatsnce abuse anxiety -PTSD -ADHD -learning disorders
CONDUCT DISORDER TREATMENT
-family therapy
-behavioral management
- specialized residential treatment
- medications for comorbidities and symptoms
- stimulants/clonidine
- mood stabilizers
-antidepressants
anti anxiety
EXSPOSURE TO TRUMA
variable symptoms
- anxiety
- depression
- dissociation
- anger
- withdrawl
- attachment difficulty
STAGED MODEL OF TREATMENT FOR TRAUMA
STAGE ONE
- provide safety and stabilization
- creating a safe and predictable environment
STAGE TWO
- reduce arousal
- find comfort from others
- overcome avoidance and work with memories
- help patient learn strategies
STAGE THREE
- developemtal skills
- problem solving
- goal development
POSTTRAUMATIC STRESS DISORDER
-direct experience or witnessing
-most common trauma exsposuress
physical abuse
sexual abuse
violence
kidnapping
terrorist attacks
accidents
natural diasters
PAOSTTRUAMATIC STRESS DISORDER SYMPTOMS
-intrusive memories of event
-recurrent frightening dreams
- dissociative reactions including flashbacks
- intense psychological distress when reminded
- play that includes elements or event
- behaviors not developmentally expected
- avoidance of reminders
negative alterations in cognition and mood
PTSD COLLABORATIVE INTERVENTIONS
- trauma focused cognitive behavioral therapy
- psychological first aid
- relaxation techniques
- medications for symptoms
EARLY ONSET DISORDERS
- depression
- bipolar disorder
- anxiety disorder
- schizophrenia
EARLY ONSET DEPRESSION
TODDLERS
-can show regression behaviors
PRESCHOOLERS
- destructive play
- whne, show irritability, and lack of confidence
SCHOOL AGED academic struggles change in physical activity somatic complaints loss of friends signs of boredom low self esteem
ADOLESCENTS talk of running away academic struggles lack of involvement in activities poor self care - difficulties with parents or teachers focus on violence
SUICIDE RISK FACTORS
family history of SI exsposure to family violence impulsivity impulsivity substance abuse availability to lethal means
BIPOLARDISORDER
-overly silly mood or joyful mood
-sleeping little without feeling tired
-talking a lot
-extremely short temper
-unusual irritability
- engagement in high risk behaviors
may also have typical adult symptoms
ANXIETY
-generalized anxiety disorder symptoms same as adult
- intense worry over a long period of time
- separation axiety
-developmentally inappropriate
excessive anxiety about separation
recurrent distress when sepaerated
impairs functioning
onset prior to 18
EARLY ONSET SCHIZOPHRENIA
- unusual behaviors
- shyness,hesitancy,withdrawl, cognitive dysfunction
- experience more hallucinations than delusions
- childish theme of hallucinations may be noted
increased likelihood of experiencing
developmental delay
hospitalization
more severe symptoms
functional problems
