neurodevelopment d/o (329 E3) Flashcards
speech disorders
problems in making sounds
language disorders
-difficulty understanding or in using words in context & appropriately
-may be evidence by inability to follow directions
-expressive language disorder
-social communication disorder
expressive language disorder
impairment or inability to develop the skills to communicate verbally or through sign language
social communication disorder
problems communicating socially -> interrupts others, being minimally verbal
motor disorders: developmental coordination disorder
-Impairments in motor skill development
-Coordination below the child’s developmental age
motor disorders: stereotypic movement disorder
Repetitive, purposeless movements for 4 weeks or more
motor disorders: tic disorders
Sudden nonrhythmic and rapid motor movements or vocalizations -> 3 types
1) Tourette’s disorder
2) Persistent motor or vocal tic disorder-more than one year
3) Provisional tic disorder-less than 1 year
what is the most severe tic disorder
tourettes -> involves multiple motor tics and one or more motor tics throughout the day for over a year, impairs functioning
treating tic disorders
-Behavioral techniques (like habit reversal)
-Relaxation Strategies
-Medications: antipsychotics, clonidine, klonopin, fluoxetine and sertraline
-Deep brain stimulation (DBS)
specific learning disorders
Dyslexia (reading)
Dyscalculia (math)
Dysgraphia (written expression)
IDDs create deficits in
- intellectual functioning
- social functioning
- daily functioning
when do we like to start interventions for IDD
around age 3, do better in the long term if started before age 5
Application of the Nursing Process
-Assessment guidelines
Assess for delays
Assess for signs of potential neglect or
abuse
-Diagnosis
-Outcomes identification
Use spoken language, engages in simple
social interactions and accepts assistance
or feedback without frustration, refrains
from acting impulsively or harming self or
others
-Implementation
Psychosocial interventions: social skills
training & therapy (Individual, Family, &
Cognitive).
-Evaluation
autism spectrum disorders
non progressive, pervasive developmental disorder that exhibits symptoms in 3 areas: socialization, communication and behavior
individuals with autism…
may be withdrawn and react unusually to other people, frequently engage in repeated body movements (like hand flapping, rocking), they have unusual attachments to selected specific objects, can be aggressive towards others or themselves, thrives with routine
review application of nursing process
for autism spectrum disorder
what screening should be done during ASD eval because intoxication can show similar signs to autism
lead
ADHD
Persistent pattern of inattention, hyperactivity, and impulsiveness that is pervasive and inappropriate for developmental level. In at least 2 settings: causing work, social, or educational difficulties for at least 6 months before age 12
3 types:
-Hyperactivity-impulsivity type
-Inattentive type
-Combined type
ADHD Hyperactivity-impulsivity Type
6 or more present for 6 months
Hyperactivity behaviors:
-Often fidgets; moves feet; squirms in seat; can’t sit still
-Leaves seat before excused
-Runs about/climbs excessively or at inappropriate times
-Difficulty playing quietly (e.g. Board games)
Is often “on the go” or often acts as if “driven by a motor”
-Often talks excessively/ non-stop talkers
Impulsivity behaviors:
-Often blurts answers before questions finished; speaks before thinking
-Often interrupts or intrudes on others (Butts into conversations or games)
-Problem waiting for his/her turn
ADHD: Inattentive Type
6 or more present for 6 months
-Does not give attention to details or makes repeated careless mistakes
-Trouble keeping attention on tasks or activities
-Often does not seem to listen when spoken to directly
-Does not follow through with completion of task/activity
-Often has trouble organizing activities
-Avoids, dislikes doing tasks that involve mental effort
-Loses things, distracted, or forgetful
-Easily bored
-Disorganized
ADHA: combined type
has behaviors from hyper, impulsive & inattentive
treatment of ADHA
-behavioral mgt + meds
-parent management training
-inc problem solving skills & coping mechanisms
-group therapy
ADHA treatment emphasizes
self regulation, social functioning, concentration, attention & focus
what is the 1st line pharm treatment for ADHA
stimulants
2nd line is non stimulants & antidepressants
stimulants MOA
increase the amount of dopamine in the brain which has a paradoxical calming/focusing effect on the brain in a person with ADHD
if you take w/o ADHA, will get revved up effect
ADHD Meds: Stimulants
-Improve attention and FOCUS, dec hyperactivity
-Begin at a low dose and work your way up.
-Not ‘weight dependent’ (even in peds)
-can try multiple types of stim if one doesn’t work
-Long-acting stimulants have a duration of 8-12 hours and can be used just once a day
long acting stimulants
dextroamphetamine/amphetamine
lisdexamfetamine
dexmethylphenidate
methylphenidate (Daytrana, Metadate CD, Ritalin LA, Concerta)
intermediate acting stimulants
dextroamphetamine
methylphenidate (Ritalin SR, Methylin ER, Metadate ER)
short acting stimulants
methylphenidate (Ritalin)
dexmethylphenidate
dextroamphetamine
amphetamine sulfate
SE to stimulants
-Decreased appetite (leads to wt loss), headaches, stomachaches, trouble getting to sleep, jitteriness, and social withdrawal.
-Nervousness, overstimulation, tachycardia or bradycardia, hypertension, restlessness, insomnia, dry mouth, unpleasant taste, diarrhea.
managed by adjusting dose or time given
if a child is on a stimulants and appears dull or overly restricted
treat by decreasing dose or changing to different medication
what is a drug holiday
when a person can stop taking their med for a certain period because they are not participating in the event that causes the need for the med (i.e. not taking adha med on the weekends bc the child uses it for school)
dextroamphetamine/amphetamine
Approved for use in children over the age of six years; capsule can be opened and sprinkled onto applesauce if can’t take pill
methylphenidate: daytrana
-May cause permanent skin color changes.
-Available in patch form.
-Worn for about nine hours on child’s hip. Continues to work for a few more hours once removed.
-Benefit: flexibility in amount of time worn and therefore dose.
methylphenidate: methylin
comes in chewable tablet and oral solution
methylphenidate: ritalin LA
Unlike the other long-acting forms of methylphenidate, capsules can be opened and sprinkled on food
methylphenidate: concerta
only approved for children over the age of six year
what is the only FDA approved medication stimulant for treating ADHA in children under 6 years old
dexadron (a trade drug of dextroamphetamine) -> can be used from ages 3 to 16
when would we use a non stim for ADHA
-if stims aren’t working
-if there is abuse
-if person is giving away stim
ADHA meds: non stims
-atomoxetine (SNRI)
-bupropion (NDRI)
-clonidine
- guanfacine
-imipramine (TCA)
atomoxetine
-Not used as often as stimulants, slow therapeutic response
-Used for children (> 6 yrs.) especially helpful for children with ADHD who also have some anxiety
-SE: Dry mouth, dizziness, nausea and vomiting, decreased appetite, and trouble sleeping; observe CLOSELY for SI
clonidine
-beta blocker
-Alone or with a stimulant; especially good if tics present with ADHD
-SE: Dry mouth, dizziness, mild sedation, constipation. Symptoms usually resolve after several doses
if a child is on a stimulant, what do we do during evals
random drug screens -> if negative we will not prescribe stims anymore because this means person is selling vs taking
bupropion SE
Dry mouth, dizziness, nausea, appetite changes, stomach pain, headache, ringing in ears, sore throat, and muscle pain.
ADHA practical tips
Schedule
Organize everyday items: Have a place for everything and keep everything in its place
Use homework and notebook organizers
Be specific, clear and consistent: Children with ADHD need clear consistent directions and rules they can understand and follow
Give praise or rewards when rules are followed
Set and reward small attainable goals.
review effective treatments
for autism
