UNIT 4 CHILD & ADOLESCENT DISORDERS Flashcards
Autism spectrum disorder that ranges from…
Mild to severe
- A group that might have difficulty dressing themselves
- Mid-level group
- A high-end, fully verbal group
What is high functioning autism?
Some are intellectually gifted and are known as savants. They excel in particular areas (music, art, memory, math or perceptual skills such as puzzle building)
What is the etiology of ASD?
- Cause is unknown
- Researches are investagating a number of theroris including the link between hereditary, genetic, medical, neuroinflammation, damage to cellular tissue and environmental factors)
- The scientific evidence to date supports that there is no link between the MMR and thimerosal containing vaccines
- Research has shown that antidepressant usue during the second or third trimaster can double the risk of their baby developing ASD
WHat are some basic clinical manifestations of ASD?
- Social interaction
- Communication
- Behavior
What are some social differences you may see in a child with ASD?
- Doesnt maintain eye contact or makes very little eye contact
- Doesnt respond to a parents smile or other facial expressions
- Doesnt look at objecs a parent is looking at or pointing.
- Doesnt point to objects to get parent to look at them
- Doesnt bring objects of interest to show a parent
- Often doesnt have appropriate Facial features
- unable to perceive what others might be thinking or feeling by looking at their facial expressions
- Doesnt show concern or empathy for others
- Unable to make friends or uninterested in making friends
What communication impairments might we see in a child with ASD?
review this one until you know it
1. Range from absent to delayed speech
2. May lose language or other social milestones (regression)
3. Should have hearing and speech evaluated if a delay or regression is noted
Communciation differences in children with ASD include?
- Repeats exactly what others say without understanding the meaning (parrorting or echoing or echolalia)
- Doesnt respond to name being called but does respond to other sounds (like a car horn or a cats meow)
- May mix up pronouns says he went to the store instead of I
- Often doesnt want to communicate
- Doesnt use toys or other objects to represent people or real life pretend play
- May grunt or hum instead of talking
- May have a good route memory (memorization of information based on repetition)
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What are some behavior differences with children who have ASD?
- Rocks,spins, sways, twirls fingers, walks on toes for a long time, or flaps hands (called “streotypic behavior or stimming)
- These behaviors often involve repetitve movements or sounds
- Likes routines, order and rituals
- Has difficulty with change
- Doesnt imitate the actions of others.
- Plays with parts of a toy instead of the whole toy
- DOesnt appear to feel pain
- May be senstative to smells, sounds lights, texture and touch
- Unusual use of vision or gaze- looks at objects from unusual angles
- May have intense temper tanturms or show aggression.
What are other conditions a child with ASD may have?
- Intellectual disabilities (cognitive impairment)
- Feeding disorders
- Asthma
- Sleep disorders
- GI or digestive disorders (constipation common)
- Seizure disorders
- Bipolar disorder
- Anxiety disorder
What are the two screening tools used for ASD?
- Modified checklist for autism in toddlers (MCHAT)
- The ages and stages questionaire (ASQ)
What are the AAP screening recommendations?
- Standardized screening at well visits at
- 9months (developemental screening)
- 18 months (developmental +ASD screening) – MCHAT
- 24 months-30 months (developmental +autism screening)– mchat
What is the gold standard test for diagnosing ASD?
Autism diagnostic observation schedule (ADOS) is the intstrument considered to be the current gold standard for dx ASD
Therapy such as behavior modfication programs are available for ASD children what are the goals of these therapys?
- promote postive reinforcement
- Increases social awareness
- Teach communication skills
- Decrease unaceptable bhavior
- Set realistic goals
- Set clear rules
- Structure opportunities for small successes
Therapy programs such as applied behavior analysis (ABA) is available for kids who have ASD what are the goals of this therapy?
Teach, reinforces and maintains new skills and desirable behaviors
1. Communication
2. social interactions
3. reading and academics
4. Motor skills
5. Hygiene and grooming
Method to extingusih problematic behaviors
How many hours does ABA require?
min. of 25 hours per week and costs approx. 70,000 a year
What are some other therapies avail. for kids with ASD other than ABA and behavior modification programs?
- Counseling (self and/or family depending on level of ASD)
- Refer to local and state deparments of mental health and developmental disabilities (to be able to access programs that they qualify for.
- Early childhood intervention (ECI) birth to 3 years
- Preschool program for children with disabilities 3-5 years (individulized education program (IEP)
- Special education: 5-21 years (IEP)
What is ECI?
- ECI is a statewide program for families with children (birth to age 3)
- They offer speech, occupational, and physical therapy
- They work with developmental delays, disabilities, and medical diagnoses that may impact development
- Refer to ECI as soon as a diagnosis of autisum is Suspected
What are some calming activities for ASD kiddos?
- Walk breaks
- jobs that involve lifting
- jumping on a trampoline
- stress ball
- feeling velcro
- gum/lollipops
- brushing hair
- weighted blanket
What are some complimentary therapies/alternative medicene for kids with ASD?
- Massage
- Therapeutic horseback riding (hippotherapy)
- Diet supplements
- Gluten-free
- casein-free diets (protien present in dairy)
- Vitamin and omega 3 supplementation
- high fat, low carb diet (ketogenic diet)
What is hippotherapy?
- Hippotherapy is a term that refers to the use of the movemment of the horse as a stratagy used by physical therapists, occupational therapists and speech pathologitsts
MUST KNOW
What medications can be used for ASD
for tx of irritability…..
name the drug, class and reasoning
DRUG: Risperidone (risperdal) and Aripiprazole (abilify)
CLASS: Anti-psychotic
REASON: Used for treatment of irritability
- Aggressive behavior
- Delberate self-injury
- Temper tantrums
Must KNOW
What medication can help with sleep issues in a child with ASD?
Melatonin (low dose)
1. This is a hormone secreted from the pineal gland in a 24 hour circadian rhythm
2. Regulates the normal sleep/wake cycle
3. Used as a supplement for sleep promotion
Know bolded
What is our nursing care for a child with ASD?
- Decrease stimulation (private room, avoding extraneous auditory or visual distractions)
- Encouraging parents to bring security objects from home
- minimal holding, touch and eye contact
- Encourage parents to stay with the child
- Introduce them slowly to new situations and tell them directly what to do
- organize care to lessen interruptions
Must know
What is ADHD?
Refers to developmentally inappropriate degrees of:
1. Inattention
2. Ipulsiveness
3. Hyperactivity
Kids with ADHD are at greatest risk for?
- ODD
- Conduct disorder
- depression
- Anxiety disorder
- Developmental disorders (such as speech/language delays and learning disabilities)
- Tics (a spasmodic contraction of the muscles)
- Sleep apnea
What is the etiology of ADHD?
Multifactoral
1. Genetics
2. Environmental- problems with the CNS at key moments in development
must know bolded
How is ADHD diagnosed?
- Symptoms have persisted for at least 6 months to a degree that is maladaptive (stops them from adapting to new or difficult situations) and inconsistent with their developmental level
- Are the symptoms present in 2 or more settings
- At school
- At home
- Social settings
know bolded
What are 3 subtypes of ADHD?
- combined type (this is the most common type)
- predominatntly inattentive type
- Predominantly hyperactive-impulsie type
What are symptoms of inattention?
- Often fails to give close attention to details
- Often has difficulty sustaining atention in tasks or play
- often does not seem to listen when spoken to
- Often does not follow through on instructions and fails to finish schoolwork, chores, or duties
- Often has difficulty organizing tasks/activities
- Often avoids, dislikes or is reluctant to engage in taks that require sustained mental effort (such as homework)
- Often loses things necessary for tasks/activites (homework,pencils books, etc.)
- Often is easily distracted
- Often forgetable in daily activiteis
What are symptoms of hyperactivity-impulsivity?
Hyperactivity
1. Often fidgets with hands or feet or squirms in seat
2. Often leaves seat in classroom
3. Often runs around or climbs excesively in situations in which it is inappropriate
4. often has difficulty playing quietly
5. Often “on the go”
6. Often talks exccessively
Impulsivity
1. often blurts out answers before questions have been completed
2. often has difficulty awaiting turn
3. often interrupts others
must know bolded
Evaluation of adhd includes?
- Primary pedi health care provider
- developmental pedi
- pediatric neurologis
- psychologist or psychiatrist
- classroom teachers
- Medical hx (including developmental hx)
- pregnancy and birth history
- Physical exam (including vision and hearing)
- Neurological eval
- psychological testing (projective testing & IQ & achievement level)
- Behavioral checklists and adaptive scales
Therapeutic management of ADHD includes?
- Family education and counseling
- medication
- proper classroom placement
- environmental manipulation
- behavioral therapypsychotherapy-child
What is the goal of behavioral therapy for ADHD?
Focuses on the prevention of undesirable behavior
Parents should be educated on
1. Delivering postive reinforcement
2. Rewarding desired behaviors
3. Providing age-appropriate consequences
Multimodal treatment for adhd includes?
- Pharmacotherpy
- Behavioral intervention
- ADHD coaching- teaches individual to manage their inattention,hyperactivity and impulsivity by developing self-awareness and stratagies
