Neurodevelopment Disorders: Exam 3

Question 1

explain psychiatric disorders in children:

Answer 1

Not diagnosed as easily as in adults
Children lack abstract cognitive abilities and verbal skills
Children constantly changing and developing

Question 2

explain psychiatric disorders in adults:

Answer 2

Similar problems as in adults (A LOT of these disorders start in childhood)
Mood disorders
Anxiety disorders
Eating disorders

Question 3

when are you usually diagnosed with psychiatric disorders?

Answer 3

In infancy or childhood
Sometimes in adolescence

Question 4

Pervasive, usually severe impairment of
Reciprocal social interaction skills
Communication deviance
Restricted stereotypical behavioral patterns
Previously known as a pervasive developmental disorder (PPD), now viewed on a continuum called autism spectrum
Range from mild to severe behaviors and limitations

Answer 4

Autism Spectrum Disorder: Autism is considered to be an umbrella term. Viewed on a continuum on the autism spectrum. Autism is diagnosed earlier in todays world.

Question 5

Autism Spectrum Disorders (ASD) Encompasses a broad spectrum of diagnoses, which include?

Answer 5

Autistic disorder
Rett’s disorder
Childhood disintegrative disorder
Pervasive developmental disorder NOS
Asperger’s disorder

Question 6

ASD, Adapted to each individual by clinical specifiers, such as?

Answer 6

Level of severity
Verbal abilities
Associated features (genetic disorders, epilepsy, intellectual disability)

Question 7

Present by early childhood (18 months to 3 years)
More prevalent in boys

Answer 7

Characteristic Behaviors: Kids with autism make little eye contact and minimal facial expressions, have limited compacity to relate to peers and parents. Express no moods, inconclusion they have a flat affect. They cannot engage with toys or show imagination. They prefer routine, they want an order to their activities, they do not respond to questioning.

Question 8

What is the etiology for Autism Spectrum Disorder (ASD)?

Answer 8

Neurological Implications
Temporal lobe white matter enlarged
Increased surface area in temporal, frontal, and parieto-occipital lobes

Physiological Implications
Several medical conditions may be implicated in predisposition to ASD
In most cases (greater than 90%) causes of autism are unknown

Genetics
Parents of a child with ASD are at risk for having other children with ASD
Chromosomes 2, 7, 15, 16, and 17 have been implicated in ASD

Perinatal Influences
Women with asthma and allergies around the time of pregnancy have an increased risk of having a child with ASD

Question 9

What are the Cultural, Biologic, and Environmental Considerations for ASD?

Answer 9

Once thought to be rare
Current estimates are 1 in 59 children
Across all ethnic, racial, and socioeconomic groups
Increase in prevalence worldwide but somewhat lower in countries outside North America and Europe

Genetic link
Many children with autism have a relative with autism or autistic traits

Controversy with MMR vaccine
Measles, mumps, and rubella (MMR) vaccines
Research concluded there is no relationship between the vaccine and autism
Research concluded there is no link between regressive- onset of autism and vaccines

*In Peds you will provide teaching to the parent, and the MAR vaccine doesn’t cause autism and present the evidence, you cannot convivence the parents, all you can do is provide evidence to back your thoughts. *

Question 10

What are the related disorders to ASD?

Answer 10

Tic disorders
Learning disorders
Motor skills disorder
Communication disorders
Elimination disorders

Question 11

Sudden, rapid, recurrent, nonrhythmic stereotyped motor movement or vocalization
Treatment with atypical antipsychotics

Answer 11

Tic Disorder

Question 12

Multiple motor tics
One or more vocal tics

Answer 12

Tourette disorder

Question 13

Either motor or vocal tics
Not both

Answer 13

Chronic motor or tic disorder

Question 14

Achievement in reading, math, written expression
Below expected for
Child’s age
Formal education
Level of intelligence

Interference with academic achievement
School dropout rate is 1.5 times higher than average rate for all children

Answer 14

Learning Disorders

Question 15

What are the early identifications for learning disorders?

Answer 15

Reading and written expression usually identified in 1st grade
Math may go undetected until 5th grade
Effective intervention and no coexisting problems is associated with better outcomes

Question 16

Developmental coordination disorder
Impairment in coordination severe enough to interfere with coexisting communication disorder
Often coexisting with communication disorder
Adaptive physical education, sensory integration to foster normal growth, development

Answer 16

Motor Skills Disorder

Question 17

Characterized by rhythmic, repetitive behaviors
Self-inflicted injuries are common
Pain is not a deterrent to the behavior

Answer 17

Stereotypic movement disorder

Question 18

Deficit in language, speech, communication severe enough to hinder
Development
Academic achievement, or ADLs including socialization

Language disorder
Deficits in language production or comprehension
Limited vocabulary and inability to form sentences

Speech sound disorder
Difficulty or inability to form sentences or conversate

Stuttering
Disturbance of fluency and patterning of speech with sound and syllable repetitions

Social communication disorder
Inability to observe social “rules” of conversation
Deficit in applying context to conversation
Inability to tell a story in an understandable manner
Inability to take turns talking and listening with another

Answer 18

Communication Disorder

Question 19

Encopresis: repeated passage of feces into inappropriate places
Often involuntary
Can be intentional

Enuresis: repeated urination during day or night in clothes or bed after age 5
Most often involuntary
Intentional enuresis associated with disruptive behavior disorder

More common in boys than girls

Answer 19

Elimination Disorders

Question 20

Inattentiveness, over-activity, impulsiveness
Persistent pattern of inattention and/or hyperactivity and impulsivity
Often diagnosed when child starts school
Fidgeting, noisy, disruptive, unable to complete tasks, failure to follow directions, blurting out answers, lost or forgotten homework
Possibly ostracized/ridiculed by peers

Answer 20

Attention-Deficit/Hyperactivity Disorder (ADHD)

Question 21

What is the onset and clinical course for ADHD?

Answer 21

More common in boys and accounts for more child mental health referrals than any other single disorder
The ratio of boys to girls range from 2:1 in nonclinical settings to 9:1 in clinical settings
It affects 5% to 8% of school-aged children with 60% to 85% having symptoms persisting into adolescence

Children who are very active or hard to handle in the classroom can be misdiagnosed and mistakenly treated
To avoid overdiagnosis, a qualified specialist must conduct the evaluation
Overly active children may suffer from
Psychological stressors at home
Inadequate parenting
Other psychiatric disorders

A key feature of ADHD is consistency of the behaviors

ADHD is usually diagnosed when the child begins preschool, though parents may report problems from a much younger age

ADHD can persist into adulthood
Up to 60% continue to be symptomatic into adulthood

Question 22

What are the Biologic and Environmental Considerations for ADHD?

Answer 22

Causes unknown
Possible cortical-arousal
Information-processing or maturational abnormalities in the brain

Other theories
Environmental toxins (lead poisoning)
Prenatal influences (parental exposure to drugs, malnutrition)
Heredity (having a 1st degree relative increases the risk of the disorder)
Damage to brain structure and function (decreased glucose in frontal lobes of parents of children with ADHD)

Decreased metabolism in frontal lobes (decreased blood flow in frontal cortex seen in children with ADHD)

Question 23

What is the assessment for ADHD?

Answer 23

History
Fussy as infant, you don’t want to jump to saying that the baby has ADHD
Out of control
Difficulties in all major life areas

General appearance and motor behavior
Inability to sit still
Inability to carry on a conversation; abrupt jumping from topic to topic

Mood and affect
Possibly labile
Anxiety, frustration, agitation

Thought process and content
Generally, no impairment with the thought process
Assessment can be difficult depending on child’s
Age
Activity level
Developmental stage; you don’t want to mistake or make a diagnosis, because some kids go through stages faster than others. The assessment can be difficult.

Sensorium and intellectual processes
Impaired ability to pay attention; have trouble paying attention and processing
Difficulty concentrating

Judgment and insight
Poor; impulsive

Self-concept
Low self-esteem: directly related to neg. reactions to their behaviors (if you tell a kid they are bad everyday they will start to think they are actually bad)
Negative reactions to behavior

Roles and relationships
Academic problems
Social problems

Physiological and self-care
May be thin
Trouble settling down
Sleeping problems

Question 24

What is the nursing diagnosis for ADHD?

Answer 24

Diagnoses; associated outcomes
Risk for injury
Ineffective role performance
Impaired social interaction
Compromised family coping
Want them to demonstrate age appropriate task

Outcome identification
Free of injury
No violation of others’ boundaries
Demonstrate age-appropriate social skills
Complete tasks
Follows directions

Question 25

What are the nursing interventions for ADHD?

Answer 25

Ensure safety
Stop unsafe behavior
Close supervision
Instruct on behavior; watch and see if they show their behavior your expecting from them.

Improve role performance
Positive reinforcement
Manage environment

Simplify instructions
Get child’s full attention
Break complex tasks into small steps
Allow breaks

Structure daily routine
Daily schedule
Minimize changes

*Focus on the 1 good thing and not the 10 bad things, reinforce when they do the one good thing. Have to break their activities into small pieces, ex: sit and read in 5 min intervals. Break activities into easily do-able task. Timeout is a good for ADHD kids, verbal reoperations are the best response. *

Question 26

What are the pharmacologic Interventions for ADHD?

Answer 26

Stimulants:
methylphenidate (Ritalin)
amphetamine compound (Adderall)

Antidepressants
as second choice

*Stimulants: should be given in the daytime hours to prevent insomnia, should be given after the person eats. Patient education: time to recommend the mother to give the meds, give the patient breakfast then give the patient the medication, if given later the patient will end up staying up all night, due to it being a stimulant. *

Question 27

What are the goals of treatment for ADHD?

Answer 27

Managing symptoms
Reducing hyperactivity and impulsivity
Increasing child’s attention

Question 28

What are the mental health promotions for ADHD?

Answer 28

Early detection and successful intervention

SNAP-IV Teacher and Parent Rating Scale (see Videbeck Box 22.3, p. 431)

Used for initial evaluation in:
ADHD
Oppositional Defiant Disorder
Conduct Disorders
Depression

*Parents need to give positive comments and acknowledge their strengths. Know that programs and techniques are available to help. *

Question 29

What are the nurse’s roles in health promotion?

Answer 29

Childhood psychiatric disorders often result from negative family influences

Insufficient knowledge and embarrassment or reluctance to have a child diagnosed with ASD are reasons parents may delay having children evaluated if signs of developmental delay are present

There is a high comorbidity between ADHD and other disorders such as:
Substance use disorder
Antisocial behavior
Anxiety disorders
Mood disorders

An accurate diagnosis and appropriate interventions are more likely to produce the best long-term outcomes

Early intervention may include collaborating with:
School psychologist
Pediatrician
Physiotherapist
Teacher
Neurologist
Family
Speech therapist
Occupational therapist

Other instances of advocacy; what we can do as advocates for our patients:
Assisting in acquiring educational and social resources

Community education
providing tools needed to improve community behavior and coping skills
Teaching appropriate expectations of functioning based on developmental levels