Unit 7 Childhood and Neurodevelopmental Disorders ADHD and Autism Chapter 11 Flashcards
Characteristics of a mentally healthy child
- Trusts others and sees his or her world as being safe and supportive
- Correctly interprets reality and makes accurate perceptions of the envi- ronment and one’s ability to influence it through actions (e.g., self-
determination) - Behaves in a way that is developmentally appropriate and does not violate
social norms - Has a positive realistic self-concept and developing identity
- Adapts to and copes with anxiety and stress using age-appropriate behav-
ior - Can learn and master developmental tasks and new situations
- Expresses self in spontaneous and creative ways
- Develops and maintains satisfying relationships
Different types of Therapy for children
Play Therapy(BEST WAY TO INTERVIEW CHILDREN
* Aide in expressing feelings, gaining insight through literature
Bibliotherapy
* Nonverbal means of expressing difficult emotions
Expressive art therapy
* Expressing feelings, setting and evaluating goals
Journaling
* Can be used to improve physical, psychological, cognitive, behavioral and social functioning.
Music therapy
* Help the family to develop goals, provide education, gain insight
Which of the following activities is used best when conducting an interview on a pediatric patient?
A. direct approach
B. Therapeutic games
C. high activity games
D. competitive games
B. Therapeutic games
Nurses use play activities such as therapeutic games, drawings, and puppets for younger children who have difficulty responding to a direct approach.
Interventions
◦ Teamwork = safety
◦ Least restrictive interventions first
◦ Verbal de-escalation(#1 intervention especially when you see a patient pacing or agitated)
◦ Offering medications to help re-gain control
◦ Time-out/quiet room(utilize time out no more than 10 minutes
◦ Seclusion and Restrain(ALWAYS LAST RESORT)
What is the best example of the least restrictive interventions?
A. holding the child down due to hyperactivity
B. asking the patient what is causing this anger
C. verbally shouting that if they don’t stop misbehaving we will call security
D. call doctor for physical restraints
Less restrictive interventions include discussion (e.g., asking if the patient would like to talk about his anger), offering medication to help him gain control, and suggesting a time-out (e.g., his room or other quiet area).
What is an example of the MOST restrictive restraint
Finally, as a last resort, seclusion or restraint may be considered. In general, seclusion is viewed as less restrictive than restraint, where all movement is constrained.
Benefits of quiet room
A unit may have an unlocked room for a child who needs an area with decreased stimulation for regaining and maintaining self-control.
The child is encouraged to express freely and work through feelings of anger or sadness in privacy and with staff support.
What is Receptive Language disorders
Difficulty understand, following directions
MOST SEVERE, difficulty learning
Other children may have receptive problems where they experi- nce difficulty understanding or are unable to follow directions. Receptive impairment results in a poorer prognosis than does expressive impairment.
How would a patient with Receptive Language disorders present?
Their mom tells them to get her purse upstairs in her room but the child is not able to understand the instructions.
What is Expressive language disorders
Difficulty communicating, finding the right words, forming sentences
Common in adults after a stroke, pt’s can understand ,best intervention have them write down or point to picture
Children may have an expressive problem that results in difficulty in finding the right words, forming clear sentences, and using the right gestures and verbal signals.
How would a patient present with Expressive language disorders
The child has cut his knee by falling off his bike accident and is unable to form the right words to explain to his mother how it happened.
What is Social communication disorder
◦ Problems using verbal and nonverbal means for social interaction
While some children have no problem with language and no problem speaking, they may have problems relating with other people.
unable to undertstand the concept of personal space
In social communication disorder, children have problems using verbal and nonverbal means for interacting socially with others. Impairments are also evident in written communi- cation when the child is trying to relate to others.
How would a patient present with Social Communication Disorder
For example, some children don’t use gestures like waving to say “goodbye” or extending arms to be picked up. Or, they may shake their head “no” when they mean “yes.”
What is Developmental coordination disorder
impairment in motor skill development, coordination below developmental age,
problems interfere academically
How would a patient present with Developmental coordination disorder
Symptoms include delayed sitting or walking or difficulty jumping or performing tasks such as tying shoelaces.
not walking at 1 years old or not sitting up by 9 months , or having headlag at 10 months
Serious impairments in skills development or coordination are usually obvious. Less severe impairments may be less notice- able. They may be identified by the child’s avoidance of certain tasks or activities. These children typically make comments like, “I hate to draw” or “I don’t want to play kickball.”
What Is Tic disorder?
Tics are sudden, nonrhythmic, and rapid motor movements or vocalizations. Motor tics usually involve the head, torso, or limbs, and they change in location, frequency, and severity over time.
Motor tic example
Other motor tics are tongue protrusion, touching, squatting, hopping, skipping, retracing steps, and twirling when walking.
Motor tics usually involve the head, torso, or limbs, and they change in location, frequency, and severity over time.
Vocal tic example
Vocal tics are spontaneous production of words unre- lated to conscious communication and sounds such as sniffs, barks, coughs, or grunts.
Are tics stationary?
A. Yes
B. No
B. No, they are involuntary movements that can be motor or vocal
What are the 3 types of Tic disorders
THEY ARE ORGANIZED FROM LEAST INVASIVE TO MOST INVASIVE
- Provisional tic disorder: Single or multiple motor and or vocal tics for less than 1 year.
2.Persistent motor or vocal tic disorder: Single or multiple motor or vocal tics but not both for more than 1 year.
- Tourette’s disorder: Multiple motor tics and at least one vocal tic for more than 1 year.
What is Provisional tic
Provisional tic disorder: Single or multiple motor and or vocal tics for less than 1 year.
What is Persistent motor or vocal tic disorder
Persistent motor or vocal tic disorder: Single or multiple motor or vocal tics but not both for more than 1 year.
What is Tourette’s disorder
Multiple motor tics and at least one vocal tic for more than 1 year.
In reality, coprolalia—the involuntary outburst of obscene words or socially inappropriate and derogatory remarks—occurs in fewer than 10% of cases
Effects that Tic Disorders have on children
A child or adolescent with tics may have low self-esteem as a result of feeling ashamed, self-conscious, and rejected by peers and may severely limit public appearances for fear of displaying tics.
What type of technique can reduce tic expressions, comprehensive behavior intervention for tics (CBIT). How does it work?
Behavioral techniques can reduce tic expression
** They are referred to as habit reversal, and the most prom- ising form is called comprehensive behavior intervention for tics (CBIT).**
It works by helping the patient become aware of the building up of a tic urge and then using a muscular response in competition to or incompatible with the tic.
Tourette Disorder
Often co-occur with depression, OCD, & ADHD
◦ CNS stimulants can increase severity of tic
◦ Comprehensive behavior intervention for tics (CBITS) “habit reversal)
◦ Pt becomes aware of the building up of tic urge, then utilizing a muscular
response in competition to or incompatible with the tic
◦ Deep Brain stimulation
◦ When conservative tx fails
◦ Fine wire threaded to affected area that delivers electrical impulses
◦ Turn on to control tics, off while sleep
What is the treatment for Tourette disorder?
A. Cognitive behavior therapy
B. systematic desentitizatiom
C. flooding
D.Comprehensive behavior intervention for tics
D.Comprehensive behavior intervention for tics
Which of the following drugs are used to treat the symptoms of Tic disorders?
A. Amtriptiline
B. Fluoxetine
C. Setraline
D. Clonidine
D. Clonidine
Alpha 2-adrenergic agonists used to treat hypertension are also prescribed for tics.
Guanfacine
Clonidine
-they have fewer side effects than antipsychotics and slower acting.
Side effects of Guanfacine
is usually well tolerated. Side effects include somnolence(desire to sleep), lethargy, fatigue, insomnia, nausea, dizzi- ness, hypotension, and abdominal pain.
Side effects of Clonidine
used for ADHD, is used to manage tics. Common side effects of clonidine are somnolence, fatigue, insomnia, nightmares, irritability, constipation, respiratory symptoms, and dry mouth.
Deep brain stimulation
A sort of pacemaker for the brain, deep brain stimulation (DBS), is used when more conservative treatments fail. A fine wire is threaded into affected areas of the brain and connected to a small device implanted under the collarbone that delivers electrical impulses. Users of DBS can turn the device on to con- trol tics or shut it off when they go to sleep.
Which of the following drugs can increase the severity of Tic disorders?
A. Clonidine
B. Guanfacine
C. Methylphenidate
D.Lorazepam
C. Methylphenidate
Central nervous system stimulants, like
Amphetamine
Methylphenidate
those used to treat ADHD, can increase the severity of tics, so medi- cations must be carefully monitored in children with coexisting ADHD.
Can antipsychotics be used for Tic disorders?
A. Yes
B.No
Drugs with FDA approval for treating tics are the first- generation antipsychotics haloperidol (Haldol) and pimozide (Orap) and the second-generation antipsychotic aripipra- zole (Abilify). Another second-generation drug, risperidone (Risperdal), does not have FDA approval but is commonly used for tic disorders.
Learning Disorders
Dyslexia – reading words
◦ Dyscalculia – mathematics
◦ Dysgraphia – writing expression
What is Dyslexia
Dyslexia – reading words
◦ Dyscalculia – mathematics
◦ Dysgraphia – writing expression
What is Dyscalculia
◦ Dyscalculia – mathematics
trouble with algebra
What is Dysgraphia
◦ Dysgraphia – writing expression
trouble with writing their thoughts
Intellectual disabilities
Intellectual disability
◦ Characterized by deficits in:
◦ Intellectual functioning – reasoning, problem solving, abstract thinking
◦ Social Functioning – communication, social cues
◦ Daily Functioning – age-appropriate activities of daily living
Intellectual functioning
Intellectual functioning. Deficits in reasoning, problem solving, planning, judgment, abstract thinking, and academic
ability.
Social functioning
Social functioning. Impaired communication and language,
interpreting and acting on social cues, and regulating emo-
tions.
Daily functioning
Daily functioning. Practical aspects of daily life are impacted
by a deficit in managing age-appropriate activities of daily living, functioning at school or work, and performing self- care.
What is autism spectrum disorder
IS THE UMBRELLA TERM
Autism spectrum disorder is a complex neurobiological and developmental disability that typically appears during a child’s first 3 years of life. Autism spectrum disorder affects the normal development of social interaction and communication skills. It ranges in severity from mild to moderate to severe.
Puberty can be turning point to improvement or deterioration
S/s of autism
Symptoms associated with autism spectrum disorder include deficits in social relatedness, which are manifested in disturbances in developing and maintaining relationships. Other behaviors include stereotypical repetitive speech, obses- sive focus on specific objects, over adherence to routines or rituals, hyperreactivity or hyporeactivity to sensory input, and resistance to change.
Sx seen in infancy – fails to be interested in others or fails to be socially responsive through eye
contact/facial expressions
Why is early intervention key?
early intervention is key before school age , so it does not interfere with developmental age chart or stages
early intervention can also greatly enhance potential for full productive life
What can occur if interventions are never set for pt’s with autism spectrum disorder?
without interventions , they may not be able to live independently or work independently
What is savant syndrome
Some individuals with autism spectrum disorder may have low IQs yet are brilliant in specific areas. These areas include musical, visual-spatial, or intellectual abilities such as pho- tographic memory recall or the ability to complete complex mathematical calculations. This is a condition known as savant syndrome.
Early intervention program for Autism
Early Intervention Programs
◦ Multidisciplinary team
◦ Identify deficits – develop tx plan
◦ Identify strengths and goals
Treatment plans include behavior management with a reward system, teaching parents to provide structure, rewards, consistency in rules,*and expectations at home to shape and modify behavior and foster the development of socially appropriate skills.
ASD LEVEL 1
- Level 1 requires support
For children with milder forms of autism spectrum disorder,
it is reasonable to expect greater participation and input from the child with supports in place to help with transitions, changes in routine, and difficulties with social and emotional reciprocit
difficulty for social skills
ASD LEVEL 2
- Level 2 requires substantial support
Individuals with level 2 or 3 require increasingly more support and have increasingly more profound impairments.
repetitive movements hand-flapping, fidgeting with objects or body rocking, and vocalizations such as grunting or repeating certain phrases
ASD LEVEL 3
- Level 3 requires very substantial support
Children with level 3 are nonverbal and need support with activities of daily living (ADLs). For individuals with more severe impair- ments, there will be greater reliance on the family. Family mem- bers must have clear and realistic expectations of the long-term needs of their child and be linked with the appropriate resources to assist with care and long-term planning.
need great family support , nonverbal deficiencies cannot take a shower or brush teeth.
Mom suspects her child may have ADHD what signs and symptoms should you expect her to see
CHILD CANNOT STAY STILL
ACTIVITY MUST BE PRESENT IN TWO SETTINGS AT HOME AND AT ASCHOOL
What is ADHD
Individuals with attention-deficit/hyperactivity disorder show an inappropriate degree of inattention, impulsiveness, and hyperactivity.
ADHD S/S - hyperactivity and impulsivity.
**The behaviors and symptoms associated with ADHD can include hyperactivity and impulsivity. Peer relationships are strained due to
HYPERACTIVITY AND IMPULSIVITY
-difficulty taking turns,
-unable to sit still
-poor social boundaries,
-intrusive behaviors, and
-interrupting others.
ADHD S/S- inattentive
**Those with the inattentive type of ADHD may exhibit high degrees of distractibility and disorganization. They may be…
INNATTENTIVE
-unable to complete challenging or
-unable to complete challenging tedious tasks,
-become easily bored,
-lose things frequently, or
-require frequent prompts to complete tasks.
Is there a guarantee that your child will grow out of ADHD
A. Yes
B. No
B. No
What type of therapy is most beneficial for a child with ADHD
Family is actively engaged in therapy
◦ Home environment is consistent, structured and nurturing
◦ Promotes achievement of normal development
They are taught techniques for modifying behavior; monitoring medication for effects; collaborating with teachers to foster academic success; and setting up a home environment that is consistent, structured, and nur- turing and that promotes achievement of normal develop- mental milestones.
Therapeutic effects in Stimulant medications for children with ADHD
Responses to these drugs are often dramatic and can quickly increase attention and task-directed behavior while reducing impulsivity, restlessness, and distractibility
Stimulant Drugs
Amphetamine
Dexmethylphenidate
Dextroamphetamine
Methylphenidate HCL
Side effects of methylphenidate
Side Effects – insomnia, appetite suppression, headache, abdominal pain and lethargy
-anorexia
-failure to thrive
Parent/patient teaching about methyphenidate
-encourage high calorie foods
-high protein
- encourage use meal replacements like ensure
-may cause insomnia , administer drug early in the day to prevent insomnia
Your pediatric patient with ADHD has been prescribed Methylphenidate , which of the following is a common side effects when on this medication?
A. Hyperactivity
B. Inattenttion
C. Abdominal cramping
D. hypersomnia
C. Abdominal cramping
What is the best intervention when taking stimulates that cause insomnia ?
A. take it later in the afternoon
B. Take it earlier in the day
B. Take it earlier in the day
Not surprisingly, insomnia is a common side effect while taking stimulant medications.
Treating with the minimum effective dose is essential. Administering medications no later than 4:00 in the afternoon or lowering the last dose of the day helps.
Nonstimulant drugs
Atomoxetine
Clonidine
Guanfacine
Nonstimulant overview
Non-Stimulants
◦ Preferable for those whose anxiety is increased from stimulants, active substance abuse disorder or tic
disorders
◦ Side Effects: GI upset reduced appetite, weight loss, urinary retention, dizziness, fatigue, insomnia,
increased BP, increased HR, may cause liver damage
◦ Caution with depression – associated with increase in Suicidal ideations
clonidine side effects
clonidine carries more side effects: somnolence, fatigue, insomnia, nightmares, irritability, constipation, respiratory symptoms, and dry mouth
Respiratory symptoms
a cough – you may bring up mucus (phlegm)
sneezing.
a stuffy or runny nose.
a sore throat.
headaches.
muscle aches.
breathlessness, tight chest or wheezing.
a high temperature
guanfacine side effects
The most common side effects of guanfacine are somnolence, lethargy, fatigue, insomnia, nausea, dizziness, hypotension, and abdominal pain.
