Neurodevelopmental Disorders Flashcards
Who is it harder to diagnose Neurodevelopmental Disorders in children or adults?
Not diagnosed as easily in children as compared to adults
Why is it difficult to diagnose neurodevelopmental disorders in children?
Lack of abstract cognitive abilities and verbal skills
Constantly changing and developing
What are the similar problems of neurodevelopmental disorders in children and adults?
Similar problems as in adults such as mood, anxiety, and eating disorders
When are neurodevelopmental disorders diagnosed?
Usually diagnosed in infancy or childhood; sometimes in adolescence
Autism Spectrum Disorder
Pervasive, usually severe impairment of reciprocal social interaction skills, communication deviance, restricted stereotypical behavioral patterns
Pervasive developmental disorders (PDDs) are now viewed as what?
Previous PDDs now viewed on continuum called autism spectrum
How does Autism Spectrum Disorder range?
Range from mild to severe behaviors and limitations
When does Autism Spectrum Disorder present?
Present by early childhood (18 months to 3 years); more prevalent in boys
What are the qualities of someone with Autism Spectrum Disorder?
Little eye contact, few facial expressions, limited gestures to communicate, limited capacity to relate to peers or parents, lack of spontaneous enjoyment, express no moods or emotional affect, inability to engage in play or make-believe with toys, little intelligible speech, stereotyped motor behaviors
What are the three major signs of ASD?
little eye contact
limited gestures to communicate
stereotyped motor behaviors
Etiology of ASD?
Genetic link
Controversy with MMR vaccine
How does ASD improve?
Tendency to improve with acquisition and use of language
How are the traits of ASD throughout adulthood?
Traits persist into adulthood.
What are the treatment goals of ASD?
Treatment goals: reduce behavioral symptoms, promote learning and development
What is included in the treatment for ASD?
Special education, language therapy; medications for specific target symptoms
What are specific autism interventions?
Applied Behavior Analysis (ABA).
Verbal behavior intervention(VBI)
Treatment and Education of Autistic and Related Communication-handicapped Children (TEACCH)
Applied Behavior Analysis (ABA)
Child learn positive behaviors and reduce negative ones
Verbal behavior intervention(VBI)
focuses on language skills.
Treatment and Education of Autistic and Related Communication-handicapped Children (TEACCH)
Visual cues such as picture cards to help learn everyday skills like getting dressed.
FDA approved Autism Medication Treatment
FDA approved: Risperidone & Aripiprazole (Abilify)
What is the FDA approved meds for autism used for specifically?
Autism related irritability
Tourette disorder:
multiple motor tics, one or more vocal tics. It involves uncontrollable repetitive movements or unwanted sounds (tics), such as repeatedly blinking the eyes, shrugging shoulders, or blurting out offensive words.
What is the cause of Tourette’s disorder?
Genetic involvement although exact cause is unknown.
When do tics in tourette’s appear?
Tics appear between ages 2 and 15, with the average being around 6 years of age.
Who is more likely to develop Tourette’s? By how much?
Males are about three to four times more likely than females to develop Tourette syndrome.
When do tics become controlled or lessened?
Tics often lessen or become controlled after the teen years.
What are FDA approved drugs for Tourette’s?
FDA approved haloperidol (Haldol), pimozide (Orap), and aripiprazole (Abilify)
What drugs are used off label for Tourette’s
Off label: alpha adrenergic agonists (clonidine & guanificine)
Other than drugs, what else is used for Tourette’s treatment?
Psychotherapy
Separation Anxiety Disorder
Fear and anxiety developmentally inappropriate
What is the worry for people with separation anxiety disorder?
Worry about harm to or permanent loss of major attachment figure
What is a common manifestation of anxiety?
School phobia as a common manifestation of anxiety
What is the most common anxiety disorder?
Separation Anxiety Disorder
What is the mean age that Separation Anxiety Disorder occurs?
Occurs at a mean age of 7
What are the risk factors of developing separation anxiety disorder?
Risk factors: parents with anxiety disorder (one or both), parental depression
OCD
Intrusive thoughts (obsessions), ritualized behaviors (compulsions), or both
What is the treatment for OCD?
Treatment: cognitive behavior therapy, psychoeducation, cognitive training, SSRIs
What is the nurse management of OCD?
Nursing management: distinguish between normal and pathologic; antidepressants and close monitoring (black box warning)
What mood disorder accounts for the highest percent?
Depression
How are children likely to show suffering of mood disorder?
Children more likely to show suffering through behavior rather than expression of feelings
What are medications of mood disorders?
Antidepressants for depression (use of SSRIs requiring frequent monitoring)
Mood stabilizers or antipsychotics for bipolar disorders
How is childhood schizophrenia diagnosed?
Diagnosed by same criteria as in adults
How is the functioning of children who have earlier schizophrenia diagnosis compared to later (adult) onset?
Poorer premorbid functioning than later (adult) onset*
What is the treatment for childhood schizophrenia?
Antipsychotics for symptoms
Parent education
Long-term management
Attention-Deficit/Hyperactivity Disorder (ADHD)
Inattentiveness, overactivity, impulsiveness
ADHD is a persistent pattern of what?
Persistent pattern of inattention and/or hyperactivity and impulsivity
When is ADHD diagnosed?
Often diagnosed when child starts school*
How do children with ADHD act in school? How are they treated?
Fidgeting, noisy, disruptive, unable to complete tasks, failure to follow directions, blurting out answers, lost or forgotten homework
Possible ostracize/ridicule by peers
Attention-Deficit/Hyperactivity Disorder (ADHD) etiology
Cause unknown: possible cortical-arousal, information-processing, or maturational abnormalities in the brain
Theories of ADHD etiology?
Other theories: environmental toxins, prenatal influences, heredity, damage to brain structure and functions
Parental exposure to drugs, lead
Decreased metabolism in frontal lobes
Goals of Attention-Deficit/Hyperactivity Disorder (ADHD)
Goals: managing symptoms, reducing hyperactivity and impulsivity, increasing child’s attention
What is needed to treat ADHD?
Combination of medications, behavioral, psychosocial, and educational interventions
What are home and school strategies of ADHD?
Consistent rewards and consequences
Therapeutic play
ADHD and Nursing Process Application : History
fussy as infant; “out of control”; difficulties in all major life areas
ADHD and Nursing Process Application : General appearance and motor behavior
General appearance and motor behavior: inability to sit still; inability to carry on conversation; abrupt jumping from topic to topic
ADHD and Nursing Process Application : Mood and affect:
possibly labile, anxiety, frustration, agitation
ADHD and Nursing Process Application: Sensorium and intellectual processes
impaired ability to pay attention or concentrate
ADHD and Nursing Process Application: Judgement and insight
poor; impulsive
ADHD and Nursing Process Application: Self concept
low self-esteem; negative reactions to behavior
ADHD and Nursing Process Application: Roles and Relationships
academic, social problems
ADHD and Nursing Process Application: Physiological and self-care:
may be thin; trouble settling down; sleeping problems
ADHD and Nursing Process Application: Outcome identification
Free of injury
No violation of others’ boundaries
Demonstrate age-appropriate social skills
Complete tasks
Follow directions
What is the first choice of medication used to treat ADHD?
Stimulants, also called psychostimulants, areoften the first choice of medications used to treat ADHD.
ADHD and Nursing Process Application:Interventions
Ensuring safety
Improving role performance
Simplifying instructions
Promoting structured daily routine*
Providing client and family education and support
Why are psychostimulants effective?
Offer the most effective way to reduce symptoms like impulsivity, hyperactivity, and inattentiveness.
What is the mechanism of action for Stimulants?
Block reuptake & subsequent release of
Norepinephrine
Dopamine
Adverse effects of stimulants
Insomnia
Increased heart rate
Anorexia, weight loss, growth stunted
Potential for abuse r/e to euphoria
Stimulants to treat ADHD include:
Amphetamines
Methylphenidate
Methylphenidate Agents
Amphetamines include:
Amphetamine/Dextroamphetamine combination
Dextroamphetamine sulfate (Dexedrine)
Lisdexamfetamine (Vyvanse)
Amphetamine/Dextroamphetamine combination includes:
Adderall (Immediate release)
Adderall XR (Extended release)
Methylphenidate structure is similar to what/.
This drug’s chemical structure is similar to amphetamines.
Difference between amphetamines and methylphenidate?
Methamphetamine is more potent than amphetamines*
How should you consume Methamphetamine?
Swallow caps/tablets as a whole/do not crush or chew
When are nonstimulants prescribed to someone with ADHD?
Prescribed if a person with ADHD can’t tolerate stimulant medication because of severe side effects.
Some health conditions also prevent the use of stimulants, such as certain psychiatric disorders, sleep disorders, cardiovascular disease, or a history of stimulant abuse.
Example of nonstimulant used for ADHD treatment?
Atomoxetine (Straterra)
Guanfacine (Tenex)
Clonidine (Catapres, Catapres-TTS, Duraclon, Jenloga, Kapvay)
What are the benefits of Atomoxetine (Straterra)?
Administered once a day
No potential for abuse
Effect seen in 1-3 weeks
What are the adverse effects of nonstimulant atomoxetine?
Adverse effects/ insomnia/ decrease appetite
Guanfacine (Tenex) Principal side effects
decreased blood pressure
somnolence (drowsy)
fatigue
When can you not give clonidine?
No anorexia or insomnia
Swallow tablets whole/ do not crush or chew
Mental Health Promotion Of ____
Early detection and successful intervention
Early detection of potential problems (SNAP-IV Teacher and Parent Rating Scale)
Early intervention may include collaborating with:
School psychologist
Pediatrician
Physiotherapist
Teacher
Neurologist
Family
Speech therapist
OT
Self-Awareness Issues
Recognize own beliefs about parenting, how they differ from others.
Focus on child’s and parents’ strengths, not just problems.
Support parents; efforts to remain hopeful.
Ask parents how they are doing.
