Neurodevelopment Disorders: Exam 3 Flashcards
explain psychiatric disorders in children:
Not diagnosed as easily as in adults
Children lack abstract cognitive abilities and verbal skills
Children constantly changing and developing
explain psychiatric disorders in adults:
Similar problems as in adults (A LOT of these disorders start in childhood)
Mood disorders
Anxiety disorders
Eating disorders
when are you usually diagnosed with psychiatric disorders?
In infancy or childhood
Sometimes in adolescence
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
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.
Autism Spectrum Disorders (ASD) Encompasses a broad spectrum of diagnoses, which include?
Autistic disorder
Rett’s disorder
Childhood disintegrative disorder
Pervasive developmental disorder NOS
Asperger’s disorder
ASD, Adapted to each individual by clinical specifiers, such as?
Level of severity
Verbal abilities
Associated features (genetic disorders, epilepsy, intellectual disability)
Present by early childhood (18 months to 3 years)
More prevalent in boys
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.
What is the etiology for Autism Spectrum Disorder (ASD)?
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
What are the Cultural, Biologic, and Environmental Considerations for ASD?
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. *
What are the related disorders to ASD?
Tic disorders
Learning disorders
Motor skills disorder
Communication disorders
Elimination disorders
Sudden, rapid, recurrent, nonrhythmic stereotyped motor movement or vocalization
Treatment with atypical antipsychotics
Tic Disorder
Multiple motor tics
One or more vocal tics
Tourette disorder
Either motor or vocal tics
Not both
Chronic motor or tic disorder
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
Learning Disorders
What are the early identifications for learning disorders?
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
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
Motor Skills Disorder
Characterized by rhythmic, repetitive behaviors
Self-inflicted injuries are common
Pain is not a deterrent to the behavior
Stereotypic movement disorder
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
Communication Disorder
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
Elimination Disorders
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
Attention-Deficit/Hyperactivity Disorder (ADHD)
What is the onset and clinical course for ADHD?
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
What are the Biologic and Environmental Considerations for ADHD?
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)
What is the assessment for ADHD?
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
What is the nursing diagnosis for ADHD?
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
What are the nursing interventions for ADHD?
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. *
What are the pharmacologic Interventions for ADHD?
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. *
What are the goals of treatment for ADHD?
Managing symptoms
Reducing hyperactivity and impulsivity
Increasing child’s attention
What are the mental health promotions for ADHD?
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. *
What are the nurse’s roles in health promotion?
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
