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Neurodevelopment in children Flashcards

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1
Q

what are the most common disorder among children

A

ADHD
Mood disorders
Major Depression

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2
Q

what are some effects of childhood mental illness

A

Long-term mental disorders in adulthood
Thwarted development
Diminished productivity
Conflict within family and in community
Child welfare involvement
Juvenile justice involvement
Special education resources needed
Physical health impairments

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3
Q

risk factors of mental illness in children

A

Biological factors
–Genetic predisposition
–Neurobiological
Psychological factors
–Temperament
Environmental factors
–Abuse or trauma
–Low socioeconomic status
–Parenting

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4
Q

what is resiliency

A

ability to adapt to change or adversity, protective against depression and anxiety

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5
Q

protective factors by incrreasing resilience

A

Positive self-image
Family cohesion& absence of discord
Support from significant others.
Positive relationship with at least one parent
Positive early family experiences with development of social competence.
Family support to help with environmental stressors.
Academic achievement
Positive peer relationships
Temperament

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6
Q

role of nurse in children with mental health

A

Doing a thorough assessment
Early identification is KEY!
Identifying family needs
Promoting children’s rights in treatment settings
Avoiding seclusion & restraint

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7
Q

who provides better information about internal symptoms during interview

A

child (mood, sleep, SI)

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8
Q

who provides better info about external symptoms

A

parent (behavior, relationships)

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9
Q

assessment process in children

A

Children need simple phrases (more concrete)
Corroborate information with adult
Direct questions, rather than open-ended
May use play media
May not be able to provide accurate time-line

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10
Q

interviews with preschool

A

have difficulty putting feelings into words, thinking concretely

Use play; conduct assessment in playroom

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11
Q

interviews with school age

A

able to use constructs; provide longer explanations

establish rapport through competitive games

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12
Q

interviews with adolescents

A

egocentric; increased self-consciousness; fear of being shamed

let them know what info will be shared ; direct, candid approach

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13
Q

what does the assessment include

A

Family functioning: parent-child relationship
Current problem: nature, severity, length; how upsetting? Better/ worse? Triggers/events? Describe behaviors at home, response to discipline, empathy violence, risks
History: previous treatment, family history, developmental & social
Mental status
Physical exam

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14
Q

Areas of child development review

A

Cognitive: ability to learn and solve problems. Ex: a 2-month-old baby learning to explore environment with hands or eyes; a five-year-old learning how to do simple math problems.

Social & Emotional: ability to interact with others, including helping themselves and self-control. Ex. a six-week-old baby smiling; a ten-month-old baby waving bye-bye; a five-year-old boy knowing how to take turns in games at school.

Speech & Language : ability to both understand and use language. Ex. a 12-month-old baby saying his first word; a two-year-old naming parts of her body; or a five-year-old learning to say “feet” instead of “foots”.

Fine motor: ability to use small muscles, specifically their hands and fingers, to pick up small objects, hold a spoon, turn pages in a book, or use a crayon to draw.

Gross motor: ability to use large muscles. Ex. a six-month-old baby learns how to sit up with some support; a 12-month-old baby learns to pull up to a stand holding onto furniture, and a five-year-old learns to skip.

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15
Q

Developmental assessment areas

A

Intellectual functioning
Gross motor functioning
Fine motor functioning
Cognition
Thinking and perception
Social interaction and play

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16
Q

Basic Principles of children’s behavior

A

All behavior has meaning
Address the need behind the behavior
Children want to behave and please those they care about
Children with mental health issues often cannot clearly communicate their needs

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17
Q

interventions for children and adolescents

A

Behavioral interventions
Bibliotherapy
Expressive arts therapy
Journaling
Music therapy
Family interventions
Psychopharmacology
Disruptive behavior management
Play therapy

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18
Q

Play Therapy

A

Appropriate for younger children
The “language” of children;
Vehicle for change, expression of feelings, trust, relationship building
Rooted in psychodynamic therapy
A creative and dynamic process that cannot be standardized
Therapist is in role of trusted participant –not aberrant perpetrator.

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19
Q

Communication disorders

A

speech disorders = problem making sounds

Language disorders =
Difficulty understanding or in using words in context and appropriately

May be evident by inability to follow directions

Expressive language disorder

Social communication disorder

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20
Q

Motor Disorders

A

Developmental coordination disorder = impairments in motor skill development

Stereotypic movement disorder = repetitive, purposeless movements for 4 weeks or more

Tic disorders = sudden nonrhythmic and rapid motor movements or vocalizations

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21
Q

3 types of Tic disorders

A

tourettes disorder

persistent motor or vocal tic = more than 1 year

provisional tic disorder = less than 1 year

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22
Q

Tx of tic disorder

A
  1. behavioral techniques
  2. relaxation strategy
  3. Meds = antipsychotics, clonidine, klonopin, fluoxetine and sertraline
  4. Deep Brain Stimulation
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23
Q

Dyslexia

A

Reading disorder

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24
Q

dyscalculia

A

math disorder

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25
Q

Dysgraphia

A

written expression disorder

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26
Q

Intellectual Development Disorder

A

Deficits in = intellectual, social, and daily functioning

cognitive and social stim can increase functioning if before age 5

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27
Q

Autism spectrum disorder

A

deficits in social interactions and relationships

repetitive speech or behaviors

obsessive focus on objects

routines and rituals

resistance to change

hyper or hypo reactivity to sensory

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28
Q

psychosocial interventions for ASD

A

treatment programs

behavior management

parent teaching

OT/PT

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29
Q

psychobiological interventions for ASD

A

2nd gen antipsychotics, SSRIs and stimulants

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30
Q

ASD Effective Treatments

A

Build on the child’s interests

Offer a predictable schedule

Teach tasks as a series of simple steps

Actively engage the child

Engage in highly structured activities
Provide regular positive reinforcement of behavior.

Teach early communication/social interaction skills.
Involve parents – major factor in treatment success!

Social skills training:
Helps child recognize social cues

Teaches ways to reduce stress

Uses role-playing to help play like peers.

Speech and language therapy.

31
Q

What is ADHD

A

Persistent pattern of inattention, hyperactivity, and impulsiveness that is pervasive and inappropriate for developmental level

32
Q

ADHD must occur

A

In at least 2 settings: causing work, social, or educational difficulties for at least 6 months before age 12.

33
Q

3 types of ADHD

A

Hyperactivity-impulsivity type

Inattentive type

Combined type

34
Q

ADHD hyperactivity-Impulsivity type

A

Six or more of the criteria below 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

35
Q

ADHD - Inattentive Type

A

Six or more criteria are present for 6 months
Behaviors of Inattention

=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

36
Q

Best results for ADHD treatment

A

behavioral management & FDA approved meds

37
Q

Using Stimulants for ADHD

A

Improve attention and FOCUS

decrease hyperactivity

begin low dose and work up

not weight dependent

38
Q

Long acting stimulants

A

dextroamphetamine/
amphetamine

lisdexamfetamine
dexmethylphenidate

methylphenidate (Daytrana, Metadate CD, Ritalin LA, Concerta

39
Q

INTERMEDIATE ACTING STIMULANTS

A

dextroamphetamine

methylphenidate (Ritalin SR, Methylin ER, Metadate ER)

40
Q

short acting stimulants

A

methylphenidate (Ritalin)
dexmethylphenidate
dextroamphetamine
amphetamine sulfate

41
Q

S/E of Stimulant Meds

A

Decreased appetite, headaches, stomachaches, trouble getting to sleep,
jitteriness, and social withdrawal.

Nervousness, overstimulation, tachycardia or bradycardia, hypertension, restlessness, insomnia,
dry mouth,
unpleasant taste, diarrhea.

42
Q

what to do if child appears dull or overly restricted

A

Tx by decreasing dose or changing to different med

43
Q

what to know with dextroamphetamine/ amphetamine

A

approved over age of 6

cpasule can be opened and sprinkled into applesauce

44
Q

what to know with Daytrana

A

may cause permanent skin color change

patch form

worn for 9 hours on hip; continues to work for a few hrs once removed

Benefit: felxible amount of time worn and dose

45
Q

what to know with methylin

A

chewable tab and oral solution

46
Q

what to know with Ritalin LA

A

capsules can be opened and sprinkled on food

47
Q

what to know with Concerta

A

only approved over age of 6

48
Q

only approved me for tx of ADHD under 6 years

A

Dextroamphetamine

49
Q

NON Stim ADHD meds

A

atomoxetine (SNRI)
= used for children >6 yrs

bupropion (NDRI)

clonidine (Alone or with a stim, especially good if tics present with ADHD)

guanfacine

imipramine (TCA)

50
Q

S/E of clonidine

A

Dry mouth, dizziness, mild sedation, constipation. Symptoms usually resolve after several doses.

51
Q

S/E bupropion

A

Dry mouth, dizziness, nausea, appetite changes, stomach pain, headache, ringing in ears, sore throat, and muscle pain.

52
Q

S/E atomoxetine

A

Dry mouth, dizziness, nausea and vomiting, decreased appetite, and trouble sleeping; ***observe CLOSELY for SI

53
Q

ADHD Tips

A

schedule

organize everyday items

use homework and notebook organizers

be specific, clear, and consistent

give praise or rewards

set and reward small attainable goals

54
Q

Impulse Control disorders

A

oppositional defiant disorder

conduct disorder

intermittent explosive disorder

55
Q

oppositional defiant disorder (ODD)

A

Negative, hostile, defiant, vindictive

Pattern of irritable and angry mood.

Swearing

Mood lability (angry outbursts)

Low frustration tolerance (can’t tolerate being told no

Interpersonal conflicts (argumentativeness, disobedience, tendency to blame others) They don’t think of themselves as angry or oppositional.

Stubbornness; resistance to directions; unwillingness to negotiate with adults; test limits; ignore rules; verbally aggressive; hostile.

56
Q

Risk Factors ODD

A

Genetic component; family history of mental illness

Numerous neurobiological causes identified

Environment: family dysfunction; adverse childhood experiences

Temperamental

57
Q

Treatment of ODD

A

Psychosocial interventions-parent training, group therapy, anger management, individual and family therapy, cognitive problem-solving training.

Psychobiological interventions-used to control anger and aggression such as divalproex sodium. The FDA has not approved any meds for the treatment of ODD.

58
Q

Conduct Disorder Behaviors

A

Persistent violation of basic rights of others or major age-appropriate rules or norms

Lacks empathy; does not feel guilty

Only express remorse, at “being caught”

Risk taking behaviors
Cruelty to animals

Aggressive behavior toward people / animals

Disruptive in community

Destruction of property

59
Q

Risk Factors of Conduct Disorder

A

Physical & sexual abuse

Inconsistent parenting with harsh discipline

Lack of supervision

Early institutional living or out-of- home placement

Association with delinquent peer group

Parental substance abuse

Biologic

60
Q

what is intermittent explosive disorder

A

Inability to control aggressive impulses

Mean age of onset is 13-21 years old

Leads to problems with
Interpersonal relationships
Occupational difficulties
Criminal difficulties

61
Q

Comorbidity of intermittent explosive disorder

A

Depressive, anxiety, and substance use disorders

Antisocial and borderline personality disorders

62
Q

Risk Factors of intermittent explosive disorder

A

Neurobiological abnormalities

Conflict or violence in family of origin

63
Q

Tx of intermittent explosive disorder

A

psychosocial

pharmacologic

64
Q

Impulse control disorders
Psychosocial interventions

A

Promote a climate of safety for the patient and for others.

Establish rapport with the patient.

Set limits and expectations.

Consistently follow through with consequences of rule-breaking.

Provide structure and boundaries.

Provide activities and opportunities for achievement of goals to promote a sense of purpose.

65
Q

Child Trauma & stressor-related disorders

A

Adjustment Disorder

Reactive attachment disorder

Disinhibited Social Engagement Disorder

66
Q

most prevalent form of child abuse in the US is…

A

neglect

67
Q

Intervention Stages

A

Stage 1
Provide safety and stabilization

Stage 2
Reduce arousal and regulate emotion through symptom reduction

Stage 3
Catch up on developmental and social skills; develop a value system

68
Q

Attachment Disorders

A

Reactive Attachment Disorder

Disinhibited social Engagement Disorder

69
Q

Reactive Attachment Disorder

A

Child rarely or minimally seeks or responds to comfort

social or emotional disturbance by at least 2 of:
=minimal social and emotional responsiveness to others
=limited positive affect
= episodes of unexplained irritability, sadness, or fearfulness

at least 1 of the following:
=social neglect or deprivation
=repeated changes of primary caregivers
=rearing in unusual settings

70
Q

Reactive Attachment Disorder Behaviors

A

Withdrawal, fear, sadness or irritability that is not readily explained

Sad and listless appearance

Not seeking comfort or showing no response when comfort is given

Failure to smile

Watching others closely but not engaging in social interaction

Failing to ask for support or assistance

Failure to reach out when picked up

No interest in playing peekaboo or other interactive games

71
Q

Disinhibited Social Engagement Disorder

A

1st 2 years of life

child interacts with unfamiliar adults with 2 of the following:

Reduced reservation about approaching unfamiliar adult

Overly familiar and violates social/cultural boundaries

Doesn’t check back with caregiver

Willing to go with unfamiliar person without reservation

72
Q

Severe social neglect in Disinhibited Social Engagement Disorder

A

caregiver neglect

repeated changes of caregiver

73
Q

RAD and DSED Treatment

A

include primary familial caregiver

ensure child:

being nutured, responsive and caring

Providing consistent caregivers to encourage stable attachment.

Providing a positive, stimulating and interactive environment

Addressing the child’s medical, safety and housing needs.

Increasing touch, talk, and socialization:
===Hold, hug, touch, feed, and talk to the child.

Use story-telling.

Encourage meals with other children and familial caregivers.

74
Q

Adjustment Disorder

A

reaction within 3 months of exposure to stressor

Distress affects ability to function.

Reaction is out of proportion to stressor severity.

Symptoms end by 6 months.
Anxiety
Depression
Mixed
Regressive behaviors in children
Fearful or acting out behavior

Requires support, understanding and encouragement.
Active listening, therapeutic communication skills

Assist in increasing coping skills.

Psych (12 decks)

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