Exam 3 ch 24 Flashcards
mild IQ
50-70
moderate IQ
35-49
severe IQ
20-34
profound IQ
19 or lower
IDD IQ is less than
70
characterized by a w/d of the child in the self and into a fantasy world of his or her own creation
autism spectrum d/o
abnormal or impaired development in the ability to communicate and interact with others
autism spectrum d/o
physical presentations of rocking, whole body swing, repetitive phrases, extensive use of hand gestures
autism spectrum d/o
causes include tuberous sclerosis, fragile X syndrome, maternal rubella, maternal asthma or allergies
autism spectrum d/o
minor changes can be HUGE in the life of these kids. Try to keep consistent with one care-provider
autism spectrum d/o
neurodevelopmental d/o’s
IDD, ASD, ADHD, Tourette’s
prevalence is 1 in 88 children
occurs more often in boys than girls
onset occurs early in childhood
often runs a chronic course
ASD
impairment in social interaction
impairment in communication and imaginative activity
restricted activities and interests
ASD
risperdal ages 5-16 and abilify ages 6-17
for ASD symptoms of aggression, deliberate self injury, temper tantrums, quickly changing moods
drowsiness, mild to mod increase in appetite, nasal congestion, fatigue, constipation, drooling, dizziness, and weight gain
NMS, tardive dyskinesia, hyperglycemia, and diabetes
SE of Risperdal (15-45kg get 2.5, over 45 kg get 3.5 mg per day)
no self harm, trust in at least one staff member
ASD
sedation, fatigue, weight fain, vomiting, sonmolence, and tremor, EPS
abilify SE
2 mg /day-15 mg/day (with 5mg increases each week)
abilify dosage
decreased dopamine, NE, and possibly serotonin
Neurotransmitters possibly involved in ADHD
plays a role in ability to perform executive functions, such as analysis and reasoning, and in the cognitive alertness essential for processing stimuli and sustaining attention and thought
NE
plays a role in sensory filtering, memory, concentration, controlling emotions, locomotor activity, and reasoning
dopamine
r/t disinhibition and impulsivity
decreased serotonin
maintaining attention, organization, and executive function
modulate behavior inhibition, with serotonin as the predominant central inhibiting neurotransmitter
prefrontal cortex
caudate nucleus and globus pallidus esp: regulates high level mvmts, may also be important to cognition. interruptions in these circuits may result in inattention or impulsivity
basal ganglia
learning and memory
hippocampus
regulation of emotions
limbic system
arousal and motivation and crucial for maintaining state of consciousness
RAS
amphetamines: releases more NE methylphenidate (Ritalin): blocks reuptake of NE Atomoxetine (Strattera) Bupropion alpha agonists
meds for ADHD
environmental lead
environmental cause of ADHD
smoking moms, premature, signs of fetal distress, low birth-weight, prolonged labor, any agnostia, CP, epilepsy, other CNS abnormality
causes of ADHD
disorganized or chaotic family environment
maternal mental d/o or paternal criminality
low socioeconomic status
unstable foster care
psychosocial influences to ADHD
prolonged use may stunt growth and development; monitor cardiovascular status** sudden death may occur!!
Methylphenidate (Ritalin) for ADHD
parents should report insomnia and weight loss (tachycardia)
Ritalin
blackbox warning for increased risk of suicide (first month especially) cardiovascular* and liver fxn tests**
Atomoxatine (Strattera) for ADHD
palpitations, tachycardia
anorexia, weight loss
n/v/c
severe liver damage*
Atomoxatine (Strattera), Bupropion (Wellbutrin)
individuals with hx of seizures or eating d/o should not take this med
Wellbutrin for ADHD
REBOUND SYNDROME, palpitations, tachycardia or bradycardia, constipation, dry mouth, sedation
alpha agonists for ADHD (Clonidine-Catapres, Guanfacine-Tenex, Intunix
presence of multiple motor tics and one or more vocal tics
onset may be as early as 2 years, but occurs most commonly around age 6 or 7
more common in boys than in girls
Tourette’s disorder
symptoms go into remission, decrease or disappear with age
Tourette’s d/o
more manic or psychotic symptoms may occur
while taking CNS stimulants and Strattera for ADHD-monitor mental status
eye blinking, neck jerking, shoulder shrugging, and facial grimacing
simple tics
squatting, hopping, skipping, tapping and retracing steps
complex motor tics
squeaks, grunts, barks, sniffs, snorts, coughs, and uttering obscenities, Palilaia (repeating one syllable sounds), Echolalia (parrot)
Vocal itcs
tics decrease with
SLEEP!!
should be used only with children who have severe symptoms or symptoms that impede functioning
haloperidol for tourettes
behavioral therapy
individual counseling or psychotherapy
family therapy
tourettes tx
used only with severe cases of tourettes
not recommended for children younger than 12 yo
pimozide for tourettes
atypical antipsychotics for tourettes
Risperdal
Zyprexa
Geodon* prolongs QT interval
weight gain, hyperglycemia
cardiac arrythmias for Geodon (Ziprasidone)
may be used as first choice for tourettes due to favorable side effect profile
often effective for comorbid symptoms of ADHD, anxiety, and insomnia
NOT PRESCRIBED IF PREEXISTING CARDIAC OR VASCULAR DISEASE
do not DC abruptly
alpha agonists: Clonidine (catapres) Guanfacine (Tenex, intuniv) for tourettes
progressies into conduct disorder
Oppositional defiant d/o
persistent pattern of angry mood and defiant behavior that occurs more frequently and interferes with social, educational, or vocational activities
oppositional defiant d/o
progresses into antisocial pdo
conduct d/o
lacks the aggressive nature (violence towards others) of conduct d/o
oppositional do
if power and control are issues for parents, or if they exercise authority for their own needs, a power struggle can be established between the parents and the child, which sets the stage for the development of ______
oppositional do
begins around age 8- early adolescence
2-12%
equal distribution between boys and girls after puberty
ADHD, anxiety, mood d/o are common comorbidities
oppositional d/o
characterized by passive-aggressive behaviors
oppositional d/o
hypertensive crisis may occur with CNS stimulants combined with
MAOIs
increased risk of serotonin syndrome if CNS stimulants are combined with
SSRIs
dont use with albuterol or vasopressors
Straterra
persistent pattern of behavior in which the basic rights of others and major age-appropriate societal norms or rules are violated
Conduct disorder
prior to age 10, lacks remorse
childhood onset type of conduct d/o
parental rejection, inconsistent mgmt with harsh discipline, early institutional living, frequent shifting of parental figures, large family size, absent father, parents have antisocial d/o or abuse alcohol, marital conflict and divorce, inadequate communication patterns, parental permissiveness
family influences of conduct d/o
difficult temperament by age three may develop into
conduct d/o
use projection as a defense mechanism
conduct d/o