LO Childhood and Impulse Control Disorders

Question 1

1. Difficulty Differentiating Emotional Problems in Kids:

• The challenge of distinguishing between normal emotional development in children and potential issues.
• What is considered typical behavior and what might be a cause for concern?

Question 2

2. Behavioral Manifestations:
   
   • Look for behaviors that are not age-appropriate.
   • Identify deviations from cultural norms that are considered unhealthy.

Question 3

3. Involvement of Families:
   
   • Emphasizes the importance of including families in the assessment and treatment process.
   • Recognizes the significant role families play in a child’s emotional well-being.

Question 4

Developmental Disorders:

Intellectual Development Disorders (IDD):

Answer 4

1. Definition:
   
   • Formerly known as Mental Retardation.
   • Characterized by an IQ below 70 and resulting impairment in functioning, with an onset before 18 years old.
2. Severity Levels:
   
   • Mild: IQ 50-70 (85% of cases)
   • Moderate: IQ 35-50
   • Severe: IQ 20-35
   • Profound: IQ below 20
3. Etiology:
   
   • Originates from genetic, medical, and/or environmental factors.
4. Functional Impairments:
   
   • Common difficulties in communication and self-care.
   • Often require supervision for daily activities.
5. Comorbidities:
   
   • Frequently coexists with other conditions such as ADHD, Mood Disorders, Autism Spectrum Disorders (ASD), seizures, and motor problems
6. Assessment Approach:
   
   • Assess individual strengths to encourage independence.
   • Implement behavior modification techniques.
7. Referrals:
   
   • Suggests the importance of connecting individuals with IDD to community resources, such as the Juvenile Probation Center (JPC).

Question 5

Autism Spectrum Disorder (ASD):

Answer 5

1. Symptoms Onset:
   
   • Symptoms typically appear early, even during infancy.
2. Etiology:
   
   • Multiple theories exist regarding the causes of ASD.
3. Incidence:
   
   • Affects 1 in every 36 children in the US, with a higher prevalence in boys (1 in 23).
   • Incidence has been increasing (from 1 in 150 in 2000).
4. Developmental Deficits:
   
   • Social skills and language development deficits.
   • Difficulty reading facial expressions.
   • Poor non-verbal and verbal communication.
   • Stereotyped (Example: If someone says, "How are you?" an individual with echolalia might respond with, "How are you?" instead of providing an appropriate answer.) and repetitive use of language (Example: Saying, "What time is it?" repeatedly, even if the time has already been provided.).
   • Inflexible adherence to routine.
   • Stereotyped or repetitive motor mannerisms (e.g., spinning). (Para los dos Hand-flapping is a stereotyped motor mannerism characterized by the rapid and repetitive movement of an individual's hands, typically in an up-and-down motion)
   • Intolerance for environmental changes (e.g., moving the bed).
   • Impairment in forming peer relationships.
   • Sensory integration issues.
5. Intellectual Impairment:
   
   • Over half of individuals with ASD have some degree of Intellectual Development Disorder (IDD) with an IQ below 70.
6. Gender Disparities:
   ` - Males are diagnosed four times more often than females`.
   
   • Historically, females have been underdiagnosed.
7. Early Intervention:
   
   • Crucial for better outcomes.
   • Approaches include Applied Behavior Analysis (ABA), Floortime, TEACCH, and PECS.
8. Controversial Therapies:
   
   • Diet and complementary therapies have mixed results.
9. Support Strategies:
   
   • Support groups for parents/caregivers are available.
10. Medications:
    ` - No cure, but medications like Abilify and Risperdal are FDA-approved for treating tantrums, aggression, and self-injurious behavior (SIB).`
    
    • SSRIs may be prescribed for depression and anxiety symptoms.
11. Prognosis:
    
    • Generally poor prognosis, but outcomes may be better with higher IQ and language skills. (Means: there is a note of optimism when it comes to individuals who have higher intellectual (IQ) and language abilities.)
12. Literature and Media:
    
    • Suggested reading: “The Curious Incident of the Dog in the Nighttime.”
    • Recommended watching: “The Temple Grandin Story.”

Question 6

Attention Deficit Hyperactivity Disorder (ADHD):

Answer 6

1. Characteristics:
   
   • Characterized by poor attention span, distractibility, hyperactivity, and impulsivity.
2. Etiology/Risk Factors:
   
   • Multiple factors contribute, including genetics, brain injury, lead exposure, alcohol and tobacco use during pregnancy, low birth weight, and premature delivery.
3. Prevalence:
   
   • In 2019, 9.8% of school-age kids were diagnosed with ADHD, up from 7.8% in 2003.
   • Boys are diagnosed 2-3 times more often than girls, with an average onset age of 7 years.
4. Treatment:
   
   • Medications:
     
     • CNS stimulants (e.g., Ritalin, Dexedrine, Adderall) are commonly prescribed.
       
       • Adverse effects include anorexia, insomnia, and jitteriness.
       • Careful dosage management is advised, with use not recommended after 4:00 PM.
         - 70-90% efficacy, but potential for abuse, tolerance, and withdrawal.
         
         • Atomoxetine (Strattera), a norepinephrine reuptake inhibitor, has a lower abuse potential.
         • Antidepressants (e.g., SSRIs, bupropion) may be used.`
         • Alpha agonists (e.g., clonidine and guanfacine) are employed for aggression, impulsivity, and hyperactivity.`
   • Non-Pharmacological Approaches:
     
     • Establish clear limits and a regular routine.
     • Decrease stimuli, as difficulty in “filtering out” extraneous stimuli is common.
     • Music can help some children focus.
     • Behavior modification techniques are often implemented.
     • Measures to protect from injury are necessary due to impulsivity and risk-taking behavior.
5. Gender Disparities:
   ` - Boys with ADHD may exhibit more hyperactivity, but girls might face worse long-term outcomes.`

Question 7

(MOI) Oppositional Defiant Disorder (ODD):

Answer 7

1. Characteristics:
   - Disobedience, argumentativeness, angry outbursts, poor frustration tolerance, tendency to blame others rather than taking responsibility for actions.
2. Comorbidity:
   
   • High comorbidity with ADHD, learning disabilities, mood disorders, and polysubstance abuse (PSA).
3. Risk Factors:
   
   • Harsh, inconsistent, or neglectful parenting.
   • Parental conflict, divorce.
   • Parents with PSA, Mood disorders, or Personality disorders.
   • Early institutional living (Foster care)

Question 8

Conduct Disorder (CD): Conduire DUI

Answer 8

1. Characteristics:
   - Serious violation of societal norms (e.g., aggression towards people and/or animals, destruction of property).

• More dangerous than ODD. (Oppositional Defiant Disorder))

2. Prevalence:
   
   • Most frequently diagnosed disorder among child/adolescent inpatient psychiatric units.
3. Differences from ODD:
   
   • Clear lack of empathy or remorse, which is a precursor to Antisocial Personality Disorder (ASPD).
4. Interventions:
   
   • Protect others from the client's aggression, with proactive intervention.
   • Teach and role-model social skills and anger management.
   • Treat comorbid disorders, such as referrals for learning disabilities.
   • Assist the client in taking responsibility for their behavior, with peer confrontation groups being helpful.
   • Address reproductive health, including birth control, STD screening/treatment, and drug tests as needed.

Question 9

Intermittent Explosive Disorder (IED): Il explose le moteur il a un DUI mais il le regrette.

Answer 9

• Characteristics:
  
  • Impulsive, emotional outbursts, and aggressive/violent behavior.
  • Different from Conduct Disorder (CD) as individuals with IED feel remorseful afterward.

Question 10

Anxiety Disorders:

Answer 10

1. Prevalence:
   
   • Anxiety disorders have the highest prevalence among all mental disorders in children and adolescents (8-10%).

Separation Anxiety Disorder:

• Characteristics:
  
  • Inappropriate and excessive anxiety about being away from home or the primary attachment figure.
  • Often leads to school phobia.
• Genetic Component:
  
  • Strong genetic component, especially if parents have panic disorder.

Question 11

Reactive Attachment Disorder of Infancy and Early Childhood:

[Reactive: a reaction or response to early experiences ]

Answer 11

• Causes:
  
  • Result of gross pathologic care and repeated caregiver changes.
• Types:
  
  • Inhibited type.
  • Disinhibited type.

Reactive Attachment Disorder is a condition that can happen when babies and young children don’t get the care and attention they need, especially if they experience frequent changes in caregivers. There are two types: one where the child becomes very shy and withdrawn (Inhibited type), and another where they might be too friendly with strangers and not understand personal boundaries (Disinhibited type).

Question 12

Other Anxiety Disorders:

Answer 12

• OCD (Obsessive-Compulsive Disorder), GAD (Generalized Anxiety Disorder), Social Phobia, PTSD (Post-Traumatic Stress Disorder):
  
  • Various anxiety disorders that can affect children and adolescents.

Question 13

Communication, Learning, and Motor Disorders:

Tourette’s Disorder (a Motor Disorder):

Answer 13

• Genetic Component:
  
  • Strong genetic component; males are affected two times more than females.
• Symptoms:
  
  • Motor and vocal tics (e.g., blinking, coprolalia - involuntary swearing, which occurs in less than 10%).
• Psychosocial Impact:
  
  • Low self-esteem often develops due to ridicule from other children.

Question 14

Newer Diagnoses:

Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS):

Answer 14

Newer Diagnoses:

Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS):

• Characteristics:
  
  • Associated with streptococcal infections.
  • Neuropsychiatric symptoms triggered by the body's immune response to strep infections.

Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS):

• Characteristics:
  
  • Acute onset of neuropsychiatric symptoms.
  • May be triggered by various infections or environmental factors.
  • Symptoms may improve with antibiotics and/or anti-inflammatory agents.

Question 15

Nursing Implications:

Answer 15

• Assessment:
  
  • Assess for maltreatment and abuse. Mandated reporting is crucial.
  • Evaluate for Danger to Self (DTS) and Danger to Others (DTO).
  • Understand age-appropriate developmental tasks and milestones.
  • Involve the family, especially in behavior modification and cognitive-behavioral therapy.
  • Provide education on medications, including stimulants, antidepressants, antipsychotics, and mood stabilizers.

Question 16

Nursing Implications:

Interventions:

Answer 16

• Therapies:
  
  • Family Therapy
  • Group Therapy
  • Milieu Therapy
  • Behavioral Therapy
  • Cognitive Behavioral Therapy
• Specific Techniques:
  
  • Quiet Room
  • Time Out
  • Play Therapy
  • Mutual Storytelling
  • Therapeutic Games
  • Bibliotherapy
  • Therapeutic Drawing

Question 17

Nursing Implications:

Answer 17

• Treatment Approaches:
  
  • Psychopharmacology

Techniques for Managing Disruptive Behavior (Box 11-3):

Question 18

Elimination Disorders in Children:

Enuresis:

• Definition:
  
  • Repeated voiding of urine into the bed or clothes.
• Causes and Interventions:
  
  • Constipation is a major cause of both enuresis and encopresis.
  • Assessment and treatment for constipation are crucial.
• Therapeutic Approach:
  
  • Behavioral therapy, such as the bell and pad technique, can be helpful for enuresis.

Question 19

Elimination Disorders in Children:

Encopresis:

Answer 19

• Definition:
  
  • Repeated passing of feces into inappropriate places (e.g., bed or the corner of the room).
• Connection with Constipation:
  
  • Constipation is a major cause of both enuresis and encopresis. Treating constipation is a priority.
• Psychosocial Aspect:
  
  • Assess for stressors, especially with encopresis. Therapy can be beneficial in addressing underlying issues.

Question 20

Extra: Treatment for ASD . Autism

Answer 20

Certainly! Let’s break down Behavior Analysis (ABA), Floortime, TEACCH, and PECS in simple terms with examples:

1. Behavior Analysis (ABA):
   
   • Explanation: ABA is a therapeutic approach that focuses on understanding and modifying behavior. It involves breaking down complex behaviors into smaller components and using positive reinforcement to encourage desired behaviors.
   • Example: Suppose a child with autism has difficulty making eye contact. ABA might involve breaking down eye contact into smaller steps, reinforcing each step, and gradually building up to longer periods of eye contact through positive reinforcement like praise or rewards.
2. Floortime (DIR/Floortime):
   
   • Explanation: Floortime is a play-based intervention that emphasizes engaging with a child based on their interests and developmental level. It focuses on building emotional connections and encouraging social interactions.
   • Example: If a child enjoys playing with toy cars, a Floortime session might involve joining the child on the floor, playing with the cars together, and gradually introducing new elements to expand the play and promote interaction.
3. TEACCH (Treatment and Education of Autistic and Communication Handicapped Children):
   
   • Explanation: TEACCH is an approach that provides structured environments and visual supports to help individuals with autism navigate their surroundings and daily activities. It aims to enhance independence and reduce anxiety.
   • Example: Using visual schedules with pictures or written words to outline the steps of a daily routine, such as getting ready for school or completing a task. This visual support helps the individual understand and follow the sequence of activities.
4. PECS (Picture Exchange Communication System):
   
   • Explanation: PECS is a communication system that uses pictures or symbols to help individuals with communication challenges express their needs and desires. It often starts with exchanging pictures for desired items or activities.
   • Example: If a child wants a snack, they might give their communication partner a picture of the specific snack they want. This helps the child communicate their preference without relying solely on verbal language.