DEVELOPMENTAL DISORDERS
INTELLECTUAL DISABILITY (ID)
Below-average intellectual functioning or less than 70
accompanied by significant limitations in areas of
adaptive functioning.
LEVELS OF ID
• Mild (IQ 50 to 70)
• Moderate (IQ 35 to 49)
• Severe (IQ 20 to 34)
• Profound (IQ below 20)
DEVELOPMENTAL CHARACTERISTICS RELATED TO
LEVEL OF MENTAL RETARDATION (DSM-V CRITERIA)
1. MILD ID
• No unusual physical sign
• Can acquire practical skills.
• Useful reading and math skills
• Can conform socially.
• Can acquire vocational skills.
• Integrated into general society.
2. MODERATE ID
• Noticeable delays
• May have some unusual physical signs.
• Can learn simple communication.
• Can learn elementary health.
• Can participate in simple activities.
• Can perform tasks in sheltered conditions.
• Can travel alone to familiar places.
3. SEVERE ID
• Marked and obvious delays
• Little or no communication skills
• May be taught daily routines.
• May be trained in simple self-care.
• Need direction and supervision.
4. PROFOUND ID
• Marked delays in all areas.
• Congenital abnormalities often present
• Need close supervision.
• Often need attendant care
• May respond to regular physical activity.
• Not capable of self-care
CAUSES
• Heredity – Tay-Sachs
• Pregnancy or Perinatal Problems
• Medical conditions of infancy
• Environmental influences
NURSING DIAGNOSIS
1. Risk for Injury
2. Self-care Deficit
3. Impaired Verbal Communication
4. Impaired Social Interaction
LEARNING DISORDERS
Diagnosed when the child’s achievement in reading,
mathematics, or written expression is below that
expected for the child’s age, formal education, and
level of intelligence.
MOTOR SKILLS DISORDER
Marked impairment in coordination, severe enough to
interfere with academic achievement or activities of
daily living.
COMMUNICATION DISORDER
Diagnosed when communication deficit is severe
enough to hinder development, academic
achievement, or activities of daily living, including
socialization.
TYPES:
1. Expressive Language Disorder
2. Receptive Language Disorder
3. Phonological
4. Stuttering
TREATMENT:
• Speech and language therapy
AUTISM SPECTRUM DISORDER (ASD)
• A group of complex disorders of brain
development.
• Previously known as AUTISM or Pervasive
Developmental Syndrome.
THREE MAJOR AREAS DSM – V
1. Social Interactions and Communication
a. Social Reciprocity – inability of the child to
responds and reciprocates.
b. Joint Attention – not wanting to share an
interest.
c. Nonverbal Communication – using or
interpreting nonverbal cues from someone
else.
 d. Social Relationships – unable to develop 2. PERVASIVE DEVELOPMENTAL DISORDER NOT
and maintain relationships. OTHERWISE SPECIFIED (PDD-NOS)
- Also known as atypical autism.
- This is a kind of catch-all category for children
2. Restrictive and Repetitive Behaviors who have some autistic behaviors but who
• lining up toys, flapping hands, imitating. don't fit into other categories.
• fixed on certain routines.
• restrictive thinking; specific knowledge
3. CHILDHOOD DISINTEGRATIVE DISORDER
- These children develop normally for at least
3. Verbal and Non-Verbal Communications two years and then lose some or most of their
communication and social skills between 2 – 10
They have difficulty in:
years old.
• Understanding and using gestures - This is an extremely rare disorder.
• Initiating and maintaining conversations
• Repeat words or phrases.
4. ASPERGER’S DISORDER
- These children don't have a problem with
TYPES: language, but they have the same social
problems and limited scope of interests as
1. Classic or Autistic Disorder children with autistic disorder.
2. Pervasive Developmental Disorder – not
otherwise specified (PDD-NOS)
3. Childhood Disintegrative Disorder
NURSING INTERVENTIONS OF CHILDREN WITH AUTISM
4. Asperger’s Disorder
SPECTRUM DISORDER:
• Behavioral modifications
1. AUTISTIC DISORDER
• Special education
- It refers to problems with social interactions,
communications, and imaginative play in • Social skills training in groups
children younger than 3 years.
• Language therapies
- Identified usually by 18 months.
- More prevalent in boys than in girls • Occupational therapy

CLINICAL MANIFESTATIONS: OTHER RELATED DISORDERS

• Profoundly disturbed social relatedness. RETT’S SYNDROME

• Constant delay in the developmental profile.
• Beginning at 6months to 18 months, children
• Aloof and indifferent
start losing their communication and social
• Prefers inanimate objects than human
skills.
contacts.
• typically begin to lose the ability to speak,
• Temper tantrums
make eye contact and to communicate.
• Language is delayed and deviant.
• Hand movements may include handwringing,
• Stereotypical behaviors
squeezing, clapping, tapping or rubbing.

NURSING INTERVENTIONS:
DISRUPTIVE BEHAVIOR DISORDERS
1. Maintain a consistent and familiar
1. ATTENTION-DEFICIT HYPERACTIVITY DISORDER
environment.
2. Set consistent and firm limits for behaviors. Characterized by inattention, impulsiveness, and
3. Encourage verbalization of feelings and overactivity.
concerns.
4. Prevents destructive behaviors.
5. Provide routing for ADL’s. INATTENTION
• Fails to pay attention to details or makes
careless mistakes in school or activities.
• Has difficulty sustaining attention in tasks or at
play.
 • Often loses necessary items. • SEVERE
- Many conduct problems that cause
• Is easily distracted by extraneous/external
considerable harm to others.
stimuli.
• Often forgetful
AGGRESSION TO PEOPLE AND ANIMALS
- bullies, threatens or intimidates others.
HYPERACTIVITY - initiates physical fights.
- has used a weapon that can seriously harm
• Fidgets or squirms
others.
• Leaves seat when remaining seated/leaves - has been physically cruel to people and
seat inappropriately. animals.
- has stolen while confronting a victim.
- has forced someone into sexual activity.
IMPULSIVITY
• Blurts out answers.
DESTRUCTION OF PROPERTY
- has deliberately set fires.
POSSIBLE ETIOLOGIES: - has deliberately destroyed property.

1. Environmental exposures
2. Food additives and history of allergies
DECEITFULNESS OR THEFT
3. Genetic predisposition
- has broken into a house, building or car.
- lies to obtain goods or favors or to avoid
NURSING MANAGEMENT: obligations.

➢ Multidisciplinary Approach
➢ Pharmacotherapy
SERIOUS VIOLATIONS OF RULES
• CNS STIMULANTS
- Methylphenidate (Ritalin) – most common. – stays out at night, despite parental
- Dextroamphetamine (Dexadrin) prohibitions.
- Pemoline (Cylert)
– has run away from home overnight at
- Clonidine (Catapres)
least twice while living in parental or
- TCA’s (Imipramine, Desipramine, Notriptyline)
parental surrogate home.

2. CONDUCT DISORDERS
ETIOLOGY
Persistent antisocial behavior that significantly
• Genetic vulnerability
impairs ability to function in social, academic, or
• Environmental adversity
occupational areas.
• Poor coping

TWO SUBTYPES:
NURSING DIAGNOSIS
1. The childhood onset type can lead to antisocial
• Risk for Other-Directed Violence
personality disorder.
• Impaired Social Interaction
2. Adolescence onset type
• Defensive Coping
• Low Self-Esteem
CLASSIFICATIONS
• MILD NURSING INTERVENTIONS
- The person has some conduct problems
• Early intervention is more effective.
that cause relatively minor or no harm to
• Antipsychotics, lithium, or other mood
others.
stabilizers.
• MODERATE
- Number of conduct problems increase as
does the amount of harm to others.
INTERVENTIONS
• Decreasing violence and increasing
compliance with treatment
• Improving coping skills and self-esteem
• Promoting social interaction
• Providing client and family education
3. OPPOSITIONAL DEFIANT DISORDER
• Enduring pattern of uncooperative, defiant, and
hostile behavior toward authority figures that
does not involve major antisocial violations.
• 25% go on to develop conduct disorder.
• 10% are diagnosed with antisocial personality
disorder as adults.
TIC DISORDERS
Is a sudden, rapid, recurrent, non-rhythmic,
stereotypes motor movement or vocalization.
3. PROVISIONAL TIC DISORDER
A chronic idiopathic movement disorder that is
characterized by the presence of ONE motor and
ONE vocal tics for LESS than 1 year.
THERAPY
• COGNITIVE BEHAVIORAL THERAPY – identify
triggering events or feelings.
• HABIT REVERSAL TRAINING – movements
incompatible with tics.
• REDUCE ANXIETY & DEPRESSION
MEDICATIONS
1. Atypical antipsychotics - They work by altering
the effects of the chemicals in the brain that
help control body movements.
2. Antiepileptics - Help reduce the severity of tics
in some people by altering the way certain
chemicals in the brain work.

CAUSES: 3. Alpha 2 agonists - Are often used as the first-

line pharmacological treatment for tics
1. Heredity - Abnormal transmission of the
because of their more benign safety profile.
neurotransmitter dopamine is thought to play
a part in tic disorders.
2. Environment – Stress & sleep deprivation.

• Motor Tics – Typically rapid, jerky movements

of the eyes, face, neck, and shoulders.

• Vocal Tics – Most common are throat clearing,

grunting, or other repetitive noises.

TYPES OF TICS
1. TOURETTE’S SYNDROME
A chronic idiopathic movement disorder that is
characterized by the presence of multiple motor
and vocal tics for more than 1 year.

2. PERSISTENT MOTOR OR VOCAL TIC DISORDER

A chronic idiopathic movement disorder that is
characterized by the presence of ONE motor and
ONE vocal tics for more than 1 year.