W8_ADHD_CD_ASD_22_23 Flashcards
3 most common mental conditions identified in children
1) ADHD
2) Conduct Disorder
3) Autism
Pharmacotherapy for ADHD patients
**Pharmacotherapy for ADHD **
(mostly stimulants)
Ritalin (methylphenidate)
Dexedrine (dextroamphetamine)
Adderall (amphetamine)
Focalin (dexmethylphenidate)
Goal of pharmacotherapy is to reduce core symptoms such as hyperactivity, inattentiveness and impulsiveness
Pharmacotherapy for patients with conduct disorder
**Dexedrine **
(if there are signs of hyperactivity)
Ritalin
(if there are signs of hyperactivity)
Wellbutrin
Prozac
(If there are signs of depression)
Pharmacotherapy for patients with autism
Pharmacotherapy for Autism:
Medication for hyperactivity
such as** Ritalin and Lexapro**
For aggressive patients,
**anti- psychotics might be prescribed for patients.**
Diagnosis of ADHD
–> Inattention symptoms
DSM–IV–TR (APA, 2000)
Six of the following inattention symptoms:
1. Failure to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
2. Difficulty sustaining attention in tasks
3. Does not seem to listen
4. Does not follow instructions and fails to finish schoolwork, chores or duties
5. Difficulty organizing tasks and activities
6. Often avoids tasks requiring mental effort
7. Easily distracted by extraneous stimuli
8. Often loses things and are forgetful
Diagnosis of ADHD
–> Hyperactivity symptoms
DSM-IV-TR (APA, 2000)
**Six **of the hyperactivity-impulsivity symptoms:
- Often fidgets with hands/feet or squirms in seat
- Often leaves seat in classroom
- Runs and climbs excessively (restlessness)
- Had difficulty playing and engaging in leisure or other activities quietly (unable to participate quietly)
- Often “on the go” or acts as if “driven by motor”
- Talks excessively
- Blurts out answers before questions
- Has difficulty awaiting turns
- Interrupts or intrudes on others
*Symptoms present in two or more settings
Other notes for Diagnosis of ADHD patients on top of
DSM (6+ 6) symptoms
Hyperactivity and impulsivity:
1) 6 or more symptoms of hyperactivity- impulsivity for children up to age 16 years, or five or more for adolescents age 17 years and older and adults.
Symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s development level.
Family Education
-> what is the cause of ADHD in children?
Family education (Risk factors)
Hereditary, congenital brain damage, teratogenic (e.g. smoking, alcohol, lead)
Negative impact in delaying ADHD treatment
Negative impact
Affecting health, susceptible injuries, substance abuse and academic performance
What is the Prognosis of ADHD patients?
Prognosis:
- 50% have symptoms till adolescence and/or adulthood
- 50% remit totally.
–> May develop conduct disorder or substance related disorder
(See Aggression, Substance abuse disorder)
- ADHD, HD may disappear but inattentiveness & impulsivity may persist.
Monitoring Pharmacotherapy for ADHD patients
- Baseline Assessment
- Physical Examination
- Blood pressure, pulse
- Weight & Height
(Watch for growth retardation) - Ongoing Assessment
- Annually: Physical Exam
- Quarterly:
BP, Pulse, weight, height
Observe possible side effects
Headaches, stomachaches
Nausea
Insomnia
Patient Education
(ADHD)
–> Psychological Interventions
For the patient and parents
Behavioural modification
– teaches the child self–monitoring
(eg. STOP, THINK, DO)
- Social Skills training groups
- Attention training
- Speech therapy if appropriate
- Parent management training (Impt)
- Parent support group
- School interventions - academic support
ADHD Nursing Interventions
1) Establish & maintain good r/s with the clients & parents
2) Management of medication side effects
3) Enhance performance and social interactions
ADHD Nursing Interventions
1) Establish & maintain good relationship with the clients and parents
- Decrease risks for injury
- Assess frequency and severity of accidents
- Ensure safe environment
- Talk with the client about safe/unsafe behaviors
- Explain consequences directly related to undesirable behaviors
- Make corrective feedback as specific as possible
- (Don’t jump down the stairs.
- Walk one step at a time).
ADHD Nursing Interventions
- Management of medication side effects
- Insomnia: earlier dosing, co administer clonidine or trazodone at bedtime
- Reduced appetite:
- morning dosing, use Focalin
(result in less of this effect), ensuring that the child eats healthy meals - Stomachache:
Give medication with food - Mild dysphoria: (milder version of depression) Switch medication or add antidepressants as ordered
- Headache: Reduce dose
- Lethargy, sedation, impaired concentration: Reduce dose
ADHD Nursing Interventions
- Enhance performance & social interactions
- Identify factors aggravating or alleviating the client’s performance
- Provide quiet environment with minimal distraction
- Give instructions slowly and use simple language and concrete directions
- Let the client repeat instructions before doing the task
- Provide positive feedback after completion of the task
- Allow time to move around
- Teach caregivers to use the same strategies
Diagnostic Criteria for Conduct Disorder
(ADDS18)
Persistent failure to control behaviour within socially defined rules.
Manifest at least 3 of the below mentioned symptoms in the past 12 months
1) Aggression to people & animals
2) Destruction of Property
3) Deceitfulness or theft
4) Serious violation of rules
< 18 years
Associated Problems with Conduct Disorder
1) Academic performance
Poor performance at school and low grades
May have low IQ
Comorbid with reading disorder
2) Impaired interpersonal relationships
- Become unpopular with peers
Legal and Criminal acts
3) Mental Disorders
Hyperactivity, Restlessness
Impulsiveness
Depression
Factors contributing to the occurence of conduct disorders
1) Harsh and punitive parenting
(physical and verbal aggression)
2) Family dysfunction and chaotic home conditions
3) Parents’ psychopathology
(eg. Psychotic disorder, substance-related disorder)
4) Child abuse and neglect
- Violent video game playing
- Decreased norepinephrine functioning
Treatment for Conduct Disorder
- Treat comorbid substance abuse first
- Behavioural modification
- Structured children’s activities and curfew enforcement
- Social skill training
- Individual psychotherapy
- Family education and therapy
- Parental communication techniques
- School – based prevention programme
Pharmacological Interventions for Conduct Disorder
Pharmacological interventions
1. Dexedrine (if there are signs of hyperactivity)
2. Ritalin (if there are signs of hyperactivity)
3. Wellbutrin
4. Prozac (If there are signs of depression)
Nursing Interventions for Conduct Disorder
- Good R/s with p/t & family members
- Limit setting on undesirable behaviours
- Use a firm & consistent approach
- Contract with the client (ahead of time) for any special requests or privileges
- Validate the client’s feelings of frustration but remain firm
- Protect other clients from being manipulated
- Structure a daily schedule
8.Positive Reinforcement
9.Assess threats or suicidal risk seriously - “time – out” to “cooling off”
- Encourage Feelings Diary
- Encourage Verbalising feelings
- Exploring alternatives to acting out undesirable behaviours
- Teach a problem – solving strategy
- Role model appropriate communication and social skills
- Gradually introduce other clients into interaction with the client who has conduct disorder
Diagnostic Criteria for Autistic Disorder
Six (or more items) from the below mentioned list (1,2,3)
Autism Spectrum Disorder (ASD)
List 1
Qualitative impairment in social interaction
- Poor use of non-verbal behaviors
(eye contact, facial expression, gesture) - Failure to develop peer relationships appropriate to developmental level
- A lack of seeking to share enjoyment, interests, or achievement with others
- A lack of social or emotional reciprocity
Autism Spectrum Disorder (ASD)
List 2
- Qualitative impairment in communication
- Delay in, or lack of the development of spoken language
- In an individual with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
- Stereotyped and repetitive use of language
- Lack of varied, spontaneous make – believe play or social imitative play appropriate to developmental level
Autism Spectrum Disorder (ASD)
List 3
- Restricted repetitive & stereotyped patterns of behaviour, interests, and activities
- Preoccupation with one or more interests such as dates, phone numbers and timetables (abnormal in intensity or focus)
- Inflexible adherence to specific and non-functional routine or rituals
- Stereotyped repetitive mannerisms such as clapping rocking or twisting
- Persistent preoccupation with parts of objects
- Delays or abnormal functioning in social interaction or imaginative play < 3 years old
Etiology for ASD
Genetic Factors
36%-96% in monozygotic twins
0%-27% in dizygotic twins
Biological factors
- MRI studies show enlarged occipital, aprietal and temporal lobe in autism
Immunological Factors
- Reaction to maternal antibodies resulting in tissue damages during gestation
Perinatal Complications
- Maternal Bleeding
Treatment for ASD
- Language, social,and academic interventions
- Behavioural modifications to reduce disruptive behaviours
- Appropriate residential placement
- Insight – oriented individual psychotherapy
- Education programme for parents (esp concept of behavioural modification)
- Parent support group
- Medication for hyperactivity
such as Ritalin and Lexapro
For aggressive patients, anti- psychotics might be prescribed for patients.
