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Submitted to-Mrs. Blessy Prabha Assistant professor MCON, Submitted by- Jincy Jose 070504002 Ist yr MSc (N) MCON
The pervasive developmental disorder include a group of conditions in which there are delay and deviance in the development of social skills, language and communication and behavioral repertoire. Children with pervasive developmental disorders often exhibit idiosyncratic intense interest in a narrow range of activities, resist change and are appropriately responsive to the social environment. These disorders affect multiple areas of development , are manifested early in life , and cause persistent dysfunction. DSM-IV TR includes five pervasive developmental disorders ; autistic disorder, Rett’s disorder, childhood disintegrative disorder, Asperger,s disorder and pervasive developmental disorder not otherwise specified. AUTISIC DISORDER Autistic disorder , historically called early infantile autism, childhood autism or Kanner’s autism is characterized by deviant reciprocal social interaction , delayed and aberrant communication skills and a restricted repertoire of activities and interests. Epidemiology • Prevalence – autistic disorder is believed to occur at a rate of 5 cases per 10000 children . • Sex distribution- autistic disorder is four to five times more likely to have more severe mental retardation • Socioeconomic status – early studies suggested that a high socioeconomic status was more common in families with autistic children ; however these findings were probably based on referral bias.
or a family move. BEHAVIORAL CHARACTERISTICS• -Qualitative impairment in social interaction--much lack a social smile and anticipatory posture for being picked up as an adult approaches. The concordance rate of disorder in the two largest twin studies was 36 percent in monozygotic pairs versus 0 percent in dizygotic pairs in one study and 96 percent in monozygotic pairs versus about 27 percent in dizygotic pairs in the second study. do not show any physical signs indicating autistic disorder . Less or poor eye contact . • Genetic factors-in several surveys. • Biological factors-the high rate of mental retardation among children with autistic disorder and the higher than expected rates of seizures disorders suggest a biological basis for autistic disorder.several report have suggested that immunological incompatibility may contribute to autistic disorder. on first glance .mothers lack of emotional responsivity. between 2 and 4 percent of sibling of autistic children also had autistic disorder . • Immunological factors. PHYSICAL CHARACTERISTICS- -children with autistic disorder are often described as attractive and . Social development is impaired. these children do have high rates of minor physical anomalies . 2. Clinical features 1.Etiology • Psychosocial and family factors. Do not acknowledge or differentiate the most important persons in 2 . a rate 50 times in the general population. parental rage and rejection etc can contributed to development of autism. Psychosocial stressors including family discord . the birth of a new sibling. such as ear malformations. Some children with autistic disorder may be excruciatingly sensitive to even small changes in their families and immediate environment.
Their social behavior is awkward and inappropriate.. Children often spin. Enjoys music. mannerisms and grimacing are most frequent. Heightened pain threshold or an altered response to pain. do not show imitative play and they are often rigid. and line up objects and may exhibit an attachment to a particular object. 3. biting. bang . • -Stereotyped behavior---spontaneous exploratory play is absent . Deficit in the ability to play with peers and to make friends. pulling hairs. • -Disturbance of communication and language--deficit in language development and difficulty using language to communicate ideas.hyper kinesis is common behavior problem in young autistic children. Self injurious behavior are observed like head banging.and teachers and may show extreme anxiety when their usual routine is disturbed. constipation. gastric signs and symptoms like diarrhea. scratching. and febrile seizures. • Instability of mood and affect---exhibits sudden mood changes . repetitive . • -Associated physical illness--. siblings. with burst of laughing or crying without an obvious reason • Response to sensory stimuli--.over response to some stimuli and under response to some other stimuli. Aggression and temper tantrums are observed. Autistic children have significant difficulty in putting meaning ful sentences together.higher incidence of upper respiratory tract infections. or monotonous. INTELLECTUAL FUNCTIONING about 30 % of children with autistic disorder exhibit mild to moderate range of mental retardation and about 45-50 percentage of children are severely to profound mental retardation. 3 . Stereotypes .their lives –parents. • -Associated behaviors--.
SSRIs . severe hearing disorder and disintegrative psychosis. quetiapine. Medications have been reported to improve associated symptoms including aggression. Children with grandmal seizures in the late childhood or early adolescence have poor prognosis. clozapine. Course and prognosis Autistic disorder are generally a life long disorder with a guarded prognosis. hyperactivity and obsessive-compulsive behavior and stereotypes. • There are no specific medications to treat the core symptoms of autistic disorder. mental retardation with behavioral symptoms. Both language remediation and academic remediation are often required. • Careful training of parents in the concepts and skills of behavior modifications and resolution of the parents concerns may yield considerable gains in children’s languages .Differential diagnosis The major differential diagnosis are schizophrenia with childhood onset. to decrease odd behavioral symptoms and to improve verbal and non verbal communication. Children with mental retardation need intellectually appropriate behavioral interventions to reinforce socially acceptable behavior and encourage self-care skills. Autistic children with IQs above 70 and those who use communicative language by ages 5 to 7 tend to show better prognosis. risperidone. 4 . ziprasidone etc are the common drugs use for the treatment of autism. self injurious behavior. olanzapine. severe temper tantrums. cognitive and social areas of behavior. congenital deafness. Educational and behavioral interventions are currently considered the treatment of choice. Treatment • The goals of treatment for autistic disorder are to increase socially acceptable and prosocial. mixed receptive expressive language disorder.
Rett’s disorder has a genetic basis. Poor muscle coordination and an apraxic gait with an unsteady and stiffness develops. such as licking and biting the fingers and tapping or slapping. At 6 months to 2 years of age . an Australian physician identified this syndrome first. In some patients with Rett’s disorder the presence of hyper ammonemia has lead to postulation that an enzyme metabolizing ammonia is deficient. Differential diagnosis In Rett’s disorder the children shows a deterioration in the growth and in autism the will be slowed from birth onwards. The prognosis is not fully known. It has been seen only in girls and the case reports indicate complete concordance twins. psychomotor retardation and ataxia. but patients who live in to adulthood remain at 5 .. loss of previously acquired speech. The head circumference growth decelerates and produces microcephaly. Course and prognosis Rett’s disorder is progressive. all language skills are lost . In Rett’s disorder the specific and characteristic hand movements are always present. infant have age appropriate motor skills . normal head circumference and nnormal growth. and both receptive and communicative skills lost. the signs often includes loss fo purposeful hand movements. Clinical features and diagnosis during the first 5 months after birth .RETT’S DISORDER Andreas Rett. In this disorder there is development of specific deficits following a period of normal functioning after birth. however these children develop progressive encephalopathy with a number of characteristic features . Other stereotypical hand movements may occur. Etiology The cause of Rett’s disorder is unknown. Respiratory irregularity is common in children with Rett’s disorder .
It may also help to regulate the breathing disorganizations . The onset may be insidious over a period over several months or relatively abrupt with abilities diminishing in days or week. increased activity level and anxiety before the loss of function. clinical picture and course. and various metabolic disorders. Behavior therapy along with medication . it is also called as Heller’s syndrome or disintegrative psychosis. may help to control self injurious behavior. In some cases child shows restlessness . seizure disorder. tuberous sclerosis. Diagnosis and clinical features The diagnosis is made on the basis of features that fit a characteristic onset of age. The core feature of this disorder includes loss of communication skills.it has been associated with other disorders like neurological conditions . CHILDHOOD DISINTEGRATIVE DISORDER It is characterized by marked regression in several areas of development after at least 2 years of apparently normal development. The ratio of boys to girls is estimated to be between 4 and 8 boys to one girl. Treatment Treatment is symptomatic and physiotherapy has been beneficial for the muscular dysfunction and anticonvulsant treatment for the control of seizures. Differential diagnosis 6 . Etiology the cause of disintegrative disorder is unknown. marked regression of reciprocal interactions and onset of stereotyped activities and compulsive behaviors. Case reported have onset ranges from 1 to 9 years.a cognitive and social level equivalent to that in the first year of life. Epidemiology Childhood disintegrative disorder is estimated to be at least one tenth as common as autistic disorder and the prevalence has been estimated to be about one case in 10000 boys .
Treatment Because of clinical similarity to the autistic disorder the treatment of this disorder includes the same component available in the treatment of autistic disorder. the failure to develop peer relationships. but family studies suggest a possible relationship to autistic disorder. interest and activities. cognitive development or age appropriate self help skills. and an impaired ability to express pleasure in other person’s happiness. Differential diagnosis The differential diagnosis includes autistic disorder. metabolic .The differential diagnosis of childhood disintegrative disorder includes autistic disorder and Rett’s disorder. Treatment 7 . lack of social and emotional reciprocity. infectious and perinatal contributing factors. Course and prognosis the factors associated with good prognosis are a normal IQ and high level social skills. ASPERGER’S DISORDER Aspergers disorder shows severe sustained impairment in social interactions and restricted patterns of behavior. Etiology The cause of Aspergers disorder is unknown. pervasive development disorder not specified. In many cases clinical features overlap with Rett’s disorder. There are no significant delay in language. Diagnosis and clinical features The clinical features includes at least 2 of the following features like markedly abnormal communicative gestures. Course and prognosis The course of childhood disintegrative disorder is variable. There is presence of genetic. Most of the patients are left with at least moderate mental retardation. schizoid personality disorder.
.Treatment depends on the patients level of adaptive functioning. hospitalization.Assist the family in discerning the child’s regressive responses to illness. Some of the same techniques used for autistic disorder are likely to be benefit. .Delayed growth and development related to cognitive or perceptual impairment.Provide support group and education on caring for infant or child with developmental disorder. interests and activities with associated impairments in social interactions the condition often shows a better outcome than autistic disorder. Objective –client will use available opportunities to practice interactions and use available social interaction behaviors Nursing interventions.Impaired social interaction related to developmental delay or perceived differences.Identify the client’s strength 8 .use a screening tool. . Objectives – client will achieve realistic developmental or growth milestones based on existing abilities.observe for the cause of discomfort in social situations .to determine the actual deviations in the development . Nursing interventions. PERVASIVE DEVELOPMENTAL DISORDER NOT OTHERWISE SPECIFIED It is severe pervasive impairment in communication skills or the presence of stereotyped behavior.Identify coexisting health or medical conditions that may be contributing to the alteration in growth and development.Regularly compare the weight and height . .spend time with the client. NURSING MANAGEMENT 1.Note and emphasize the positive attributes of the parents and the family. . 2.
.Communicate and interact with the client in the age appropriate manner..allow the child to be independent as possible and offer help whenever necessary 3. Objective. Self care deficit( bathing.Do not raise voice or shout at he client 4. or birth of a child with developmental disorders.hygiene. .Spend time in communicating with the client .Give praise for the progress noted.Establish an understanding of the client’s symbolic speech.Listen carefully. .grooming.Model appropriate social interactions . . Nursing interventions . .Approach the client in anon judgmental manner .dressing. validate verbal and non verbal communication . toileting. Grieving related to loss of perfect child. Risk for disproportionate growth related to mental retardation 8. Interrupted family process related to crisis of diagnosis or situational transition 9 .etc ) related to perceptual or cognitive impairment 5.client will effective and alternate methods of communication and demonstrate congruency of verbal or nonverbal behavior as evidenced by exchange of message with others.when the client has difficulty in communicating asses and refer for consultation. 6.Have group members identify each members strength in a group setting. Self mutilation related to inability to express emotions or tensions verbally 7.Involve a familiar person when attempting to communicate with a person who has difficulty in communicating . Ignore mistakes.Impaired verbal communication related to developmental delay.
Synopsis of psychiatry-behavioural science or clinical psychiatry. 3rd edn. Spiritual distress related to chronic condition of the child with special needs. 5th edn.2004.Stuart GW. 1998. Laraia MT. FH Davis publishers 3. Mosby publishers. Hong Kong.Sadok BJ. Kaplan HI.9th edn.Ahuja N. Principles and practice of psychiatric nursing.A short text book of psychiatry. 10 . Jaypee brothers medical publishers. Parental role conflict related to home care of child with special needs. New Delhi. 10.Townsend MC.. Noida.William and Wilkinsons publications. 4. 1st edn. Psychiatric mental health nursing.9. REFERENCES 1.. Philadelphia.2001 2.
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