Neurodevelopmental Disorders: Chapter 22 & 23

Chapter 22 Neurodevelopmental Disorders  Psychiatric Disorders ❖Harder to diagnose in children ❖Mood, anxiety, eating disorders ❖Neurodevelopmental disorders o Intellectual developmental disorder (IDD) o Autism spectrum disorder (ASD) o Attention-deficit/hyperactivity disord...

Chapter 22 Neurodevelopmental Disorders  Psychiatric Disorders ❖Harder to diagnose in children ❖Mood, anxiety, eating disorders ❖Neurodevelopmental disorders o Intellectual developmental disorder (IDD) o Autism spectrum disorder (ASD) o Attention-deficit/hyperactivity disorder (ADHD) Copyright © 2023 Wolters Kluwer All Rights Reserved  IDD ❖Formerly known as MR ❖IQ < 70 ❖Severity: mild to profound ❖Causes may be genetic, environmental, idiopathic Copyright © 2023 Wolters Kluwer All Rights Reserved  ASD ❖ Pervasive developmental disorder (PDD) – old category ❖ Instead of variety of PDD types, now “spectrum” o Difficult to distinguish between similar disorders o Very different from person to person o Wide range of functional abilities Copyright © 2023 Wolters Kluwer All Rights Reserved  ASD ❖Present by early childhood ❖Boys > girls ❖Characteristic behaviors Copyright © 2023 Wolters Kluwer All Rights Reserved  ASD ❖ Genetic link ❖ MMR vaccine - research concluded no relationship ❖ Improve with acquisition and use of language ❖ Behavior may deteriorate during adolescence ❖ Treatment goals ❖ CBT, antipsychotics Copyright © 2023 Wolters Kluwer All Rights Reserved  Related Disorders ❖Tic disorders ❖Learning disorders ❖Motor skills disorders ❖Communication disorders ❖Elimination disorders Copyright © 2023 Wolters Kluwer All Rights Reserved  Tic Disorders ❖Abnormal dopamine transmission ❖Treatment ❖Tourette’s disorder ❖Chronic motor or vocal tic disorder ❖Transient tic disorder Copyright © 2023 Wolters Kluwer All Rights Reserved  Learning Disorders ❖Reading/writing/math skills below expected ❖Interferes with academic achievement, life activities ❖Early identification & intervention Copyright © 2023 Wolters Kluwer All Rights Reserved  Motor Skills Disorders ❖Developmental coordination disorder ❖Stereotypic movement disorder Copyright © 2023 Wolters Kluwer All Rights Reserved Communication Disorders ❖Language disorder ❖Speech sound disorder ❖Stuttering ❖Social communication disorder Copyright © 2023 Wolters Kluwer All Rights Reserved Elimination Disorders ❖Encopresis – ❖Enuresis – ❖Limitations ❖Parent/caregiver reactions ❖Treatment Copyright © 2023 Wolters Kluwer All Rights Reserved  ADHD ❖Inattentiveness, overactivity, impulsiveness ❖Often diagnosed when child starts school o Common symptoms ❖Possible ostracization/ridicule by peers Copyright © 2023 Wolters Kluwer All Rights Reserved  ADHD ❖Cause unknown ❖Theories being researched ❖Parents, children both being analyzed ❖Genetic link possible ❖Risk factors ❖Valid reporting tools Copyright © 2023 Wolters Kluwer All Rights Reserved  ADHD ❖No universal treatment ❖No cure ❖Chronic condition requiring long-term tx ❖Best results w/combo of meds & various interventions Copyright © 2023 Wolters Kluwer All Rights Reserved  ADHD Medications ❖Stimulants o Methylphenidate (Ritalin) o Amphetamine compound (Adderall) ❖Antidepressants: second choice o Atomoxetine (Strattera) Copyright © 2023 Wolters Kluwer All Rights Reserved  ADHD ❖Home and school strategies o Consistency essential o Therapeutic play Copyright © 2023 Wolters Kluwer All Rights Reserved  ADHD Assessment ❖Squirmy and wiggly ❖Cannot hold a conversation ❖Poor judgment, impulse control ❖Negative self-image ❖Most unaware their behavior is different ❖History of physical injuries Copyright © 2023 Wolters Kluwer All Rights Reserved  ADHD and Nursing Process ❖Actions o Ensuring safety o Improving role performance o Simplifying instructions o Promoting structured daily routine o Providing client/family education and support Copyright © 2023 Wolters Kluwer All Rights Reserved Self-Awareness Issues ❖Beliefs about parenting ❖Focus on strengths ❖Ask parents how they are doing Copyright © 2023 Wolters Kluwer All Rights Reserved  Chapter 23 Disruptive Behavior Disorders Disruptive Behavior Disorders ❖Oppositional defiant disorder (ODD) ❖Intermittent explosive disorder (IED) ❖Conduct disorder (CD) ❖Related disorders o Kleptomania o Pyromania Copyright © 2023 Wolters Kluwer All Rights Reserved Oppositional Defiant Disorder (ODD) ❖Certain level of this behavior common ❖Limited ability to make connection between behaviors and consequences ❖Varied prognosis ❖Parent management training Copyright © 2023 Wolters Kluwer All Rights Reserved Intermittent Explosive Disorder (IED) ❖Repeated episodes, can occur without warning ❖May physically injure others and self ❖May feel guilty afterward; still happens again ❖Most common in adolescence & young adulthood ❖More common in males Copyright © 2023 Wolters Kluwer All Rights Reserved  IED Etiology ❖Comorbid psychiatric disorders ❖Neurotransmitter imbalance ❖Frontal lobe dysfunction ❖Adverse physical outcomes Copyright © 2023 Wolters Kluwer All Rights Reserved IED Treatment Medications ❖Fluoxetine ❖Lithium ❖Anticonvulsant mood stabilizers ❖SSRIs Copyright © 2023 Wolters Kluwer All Rights Reserved  IED Treatment ❖Cognitive behavioral therapy ❖Anger management strategies ❖Avoidance of alcohol, substance use ❖Relaxation techniques Copyright © 2023 Wolters Kluwer All Rights Reserved  Conduct Disorder (CD) ❖Behavior that violates social norms ❖Callous and unemotional traits ❖Reckless/risky behaviors Copyright © 2023 Wolters Kluwer All Rights Reserved  CD ❖Subtypes based on age at onset o Childhood 10 years ( & ) ❖Behaviors vary in intensity ❖Course of disorder is variable Copyright © 2023 Wolters Kluwer All Rights Reserved  CD Etiology ❖Genes, environment, poor coping skills ❖Risk factors ❖Protective factors ❖Possible neurotransmitter roles Copyright © 2023 Wolters Kluwer All Rights Reserved  CD Assessment ❖Screening tools available ❖History ❖Swearing/cursing ❖Don’t think they need help ❖Thrill-seeker, risk-taker ❖Act tough Copyright © 2023 Wolters Kluwer All Rights Reserved  CD Treatment ❖Nothing universally suitable ❖School-age kids vs. adolescents ❖Medications ❖Long-term work done as outpatient ❖Limit-setting and consistency Copyright © 2023 Wolters Kluwer All Rights Reserved  Mental Health Promotion ❖Parenting classes as a group ❖Parent behavior individual therapy with kid ❖Fears for personal safety in the nurse ❖Focus on kids’ strengths and assets ❖No “blaming” attitude at parents or kids Copyright © 2023 Wolters Kluwer All Rights Reserved  Self-Awareness Issues ❖Recognize own beliefs & values about raising children ❖Be aware of feelings about disruptive behaviors Copyright © 2023 Wolters Kluwer All Rights Reserved