neurodevelopmental disorders

Question 1

types of neurodevelopmental disorders

Answer 1

communication disorders
motor disorders
specific learning disorder
IDD
autism spectrum disorders
ADHD

Question 2

communication disorders

Answer 2

speech- problems making sounds
language- difficulty understanding or in using words in appropriate context, may be evident by inability to follow directions, expressive language disorders( inability to communicate verbally or understand sign language)
social communication disorder (problems communicating socially, interrupting others, or minimally verbal)

Question 3

motor disorders

Answer 3

developmental coordination disorder
stereotypical disorder
tic disorder

Question 4

developmental coordination disorder

Answer 4

impairments in motor skill development
coordination below the child’s developmental age
interferes with academic achievements or ADL’s, delayed sitting, walking, difficulty jumping, tying shoes
TX: PT/OT

Question 5

stereotypic movement disorders

Answer 5

repetitive, purposeless movement for 4 weeks or more
hand flapping, waving, rocking, head banging, nail biting, teeth grinding that interferes with ADL’s
TX: helmets, mittens, behavioral therapy using habit reversal

Question 6

tic disorders

Answer 6

sudden nonrhythmic and rapid motor movements and vocalizations
tongue protrusions, hopping, skipping, twirling, touching, squatting, verbal tics and sounds

Question 7

3 types of tic disorders

Answer 7

Tourette’s (most severe)
persistent motor or vocal tic disorder- one than 1 year
provisional tic disorder- less than 1year

Question 8

treating tic disorders

Answer 8

behavioral- habit reversal
relaxation strategies- to reduce and control tics
onset usually between 4-6, symptoms peak early adolescents and sometimes resolves by adulthood
meds: antipsychotics, clonidine, klonopin, fluoxetine and sertraline
DBS

Question 9

specific learning disorders

Answer 9

dyslexia (reading)
dyscalculia (math)
dysgraphia (written expression)
*identified during school years, get IEP through special ED

Question 10

IDD

Answer 10

more in males than females
deficits in intellectual functioning, social functioning, daily functioning (school, work, selfcare)
cognitive and social stimulation can increase levels of functioning if begun before 5 years
motivational support
early identification and intervention increases quality of life

Question 11

application of the nursing process for IDD

Answer 11

assess for delays
assess for signs of potential abuse or neglect
diagnosis ( RF injury, ineffective impulse control)
outcome: use spoken language, express in simple social interactions and accepts assistance without frustration, refrains from acting on impulses, harming self or others
implementation: psychosocial interventions: social skills training and therapy

Question 12

autism

Answer 12

deficits in social interactions and relationships
stereotypical repetitive speech and/or behaviors
obsessive focus on specific objects
over adherence to routines and rituals
hyper or hypo-reactivity to sensory input
extreme resistance to change
appears normal in early childhood
*manage behaviors based on effect on environment and others, if hand flapping is not causing problems let it be.

Question 13

when does autism develop and causes

Answer 13

develops 1st 3 years of life
more common in males
if occurs in females its more severe
potential causes: advanced maternal age, genetic mutation, low birth weight, valproic acid during pregnancy
NOT vaccination related

Question 14

Nursing process with Autism

Answer 14

assessment- intellectual or developmental delays, communication, social, and behavioral skills, parent-child relationship, abuse, stereotypical behavior
diagnosis- early identification is key, lead and hearing screen, CARS and M-CHAT scales
LEAD poisoning mimics autism
outcomes- cooperation, consideration, sensitivity to others, accurately interpreting and/or exchanging messages
implementation- psychosocial interventions: treatment programs, behavior mgmt, parent teaching, PT/OT/Speech
evaluation- are there improvements and use of services

Question 15

effective treatment programs for Autism

Answer 15

build on child’s interest
predictable schedule
teach tasks as a series of simple steps
actively engage
highly structured activities (beginning, middle, end)
regular positive reinforcement
early communication/social interaction skills
involve parents
social skills training- helps recognize social cues, reduce stress, role-playing to help play like peers
speech and language therapy

Question 16

ADHD

Answer 16

persistent pattern of inattention, hyperactivity, and impulsiveness that is persuasive and inappropriate for developmental level in at least 2 settings for at least 6 months before age 12
3 types: Hyperactivity-impulsivity type, inattentive type, combined type
males more than girls, some cases go into adulthood
possible causes: low birthweight, premature, TBI, maternal smoking, drinking during pregnancy, lead paint

Question 17

ADHD impulsivity type

Answer 17

present for at least 6 months
Hyperactivity behaviors:
fidgets, squirms, cant sit still
leaves seat before excused
runs/climbs excessively
difficulty playing quietly
on the go, “driven by a motor”
Impulsivity behaviors:
blurts out answer before question is finished
interrupts or intrudes on others
problems with waiting their turn

Question 18

ADHD inattentive type

Answer 18

present for at least 6 months
behaviors of inattention:
doesnt give attention to detail, makes repeated careless mistakes
trouble keeping attention on tasks or activites
doesnt seem to listen when spoken to directly
trouble organizing activities
loses things, distracted, or forgetful
easily bored
disorganized

Question 19

combined type ADHD

Answer 19

has behaviors from hyper, impulse and inattentive

Question 20

ADHD treatment

Answer 20

self regulation, social functioning, concentration
behavioral management + meds
hospitalization only if danger to self
parent training
group therapy 8-12 weekly sessions with therapist
CBT not as affective
Play therapy
stimulants 1st line treatment
non-stimulants- 2nd line

Question 21

ADHD meds

Answer 21

improved attention and focus
decrease hyperactivity
begin low and increase dose
NOT weight dependent
if 1 stimulant is not affective try 2nd…3rd…
long acting stimulants duration of 8-12 hours, useful for school

Question 22

long acting stimulants for ADHD

Answer 22

dextroamphetamine/amphetamine
lisdexamfetamine
dexmethylphenidate
methylophenidate (Daytrana, Metadate CD, Ritalin LA, Concerta
Ritalin LA can be opened and sprinkled on food

Question 23

intermediate acting stimulants for ADHD

Answer 23

dextroamphetamine
methylphenidate ( Ritalin SR, Methylin ER, Metadate ER)

Question 24

short acting stimulants for ADHD

Answer 24

methylphenidate (Ritalin)
dexmethylphenidate
dextroamphetamine
amphetamine sulfate
Ritalin can be crushed or chewed

Question 25

side effects of stimulants for ADHD

Answer 25

decreased appetite, headaches, stomachaches, trouble getting to sleep, jitteriness, and social withdraw
nervousness, overstimulation, tachycardia or bradycardia, hypertension, restlessness, insomnia, dry mouth, unpleasant taste, diarrhea
can usually be managed by adjusting dose
child appears dull or overly restricted
can give drug holidays

Question 26

Pearls for ADHD

Answer 26

dextroamphetamine/amphetamine
over the age of 6
capsule can be opened and sprinkled on applesauce
methylphenidate (Daytrana)
patch form, can cause permanent skin color changes
work on hip for about 9 hours, continues to work for a few hours after removal
benefit is flexibility on time it can be worn
methylin: chewable tablet or oral solution
ritalin LA: can be opened and sprinkled on food
concerta: approved only for children over the age of 6
dextrogen: only approved med for under age 6 can start at age 3 (3-16)
*random drug screens for kids on stimulants, weight checks, HR, BP)

Question 27

non-stimulant ADHD meds

Answer 27

atomoxetine (SNRI)- not used as often as stimulants, slow therapeutic response
used for children 6 and older with ADHD, anxiety
buproprion (NDRI), clonidine (alone or with stimulant; especially if tic present with ADHD)
guafacine
imipramine (TCA)

Question 28

clonidine side effects

Answer 28

non stimulant
dry mouth, dizziness, mild sedation, constipation, symptoms usually resolve several doses

Question 29

bupropion side effects

Answer 29

non-stimulant
dry mouth, dizziness, nausea, appetite changes, stomach pain, headache, ringing in ears, sore throat, muscle pain

Question 30

atomoxetine side effects

Answer 30

non-stimulant
dry mouth, dizziness, n/v, decreased appetite, trouble sleeping
**observe closely for SI

Question 31

practical tips for ADHD

Answer 31

schedule
organize everday items
use homework and notebook organizers
be specific, clear and consistent
give praise or rewards when rules are followed
set and reward small attainable goals