Neurodevelopmental Disorders

NCM 117/ PSYCHIATRIC NURSING/ LECTURE

AUTISM SPECTRUM DISORDER COMPREHENSIVE AND INDIVIDUALIZED TREATMENT
• Characterized by pervasive and usually severe • Special education and language therapy.
impairment of reciprocal social interaction skills, • Cognitive behavioral therapy for anxiety and
communication deviance, and restricted agitation.
stereotypical behavioral patterns.
PHARMACOLOGIC TREATMENT
• 5x more prevalent in boys than in girls, and it is
usually identified by 18 months and no later than • Haloperidol (Haldol)
3 years of age. • Risperidone (Risperdal)
• Children with ASD have persistent deficits in • Aripiprazole (Abilify), or combinations of
communication and social interaction antipsychotic medications
accompanied by restricted stereotyped patterns of • Naltrexone (ReVia)
behavior and interests/activities. • Clomipramine (Anafranil)
• Clonidine (Catapres), and
Behavior Common with ASD • Stimulants to diminish self – injury and hyperactive
• Not responding to own name by 1 year (e.g., and obsessive behaviors.
appears not to hear)
• Doesn’t show interest by pointing to objects or RELATED DISORDERS
people by 14 months of age. 1. Tic Disorders – it is a sudden, rapid, recurrent, non-
• Doesn’t play pretend games by 18 months of age rhythmic, stereotyped motor movement or vocalization.
• Avoid eye contact Common simple vocal:
• Prefers to be alone
• Delayed speech and language skills • Clearing the throat
• Obsessive interests (e.g., gets stuck on an idea) • Grunting
• Upset by minor changes in routine • Sniffing
• Repeats words or phrases over and over • Snorting, and barking
• Flaps hands, or rocks or spins in a circle; answers Complex Vocal Tics:
are unrelated to questions
• Unusual reactions to sounds, smells, or other • Repeating words or phrases out of context
sensory experience. • Coprolalia (use of socially unacceptable words,
frequently obscene
EPIDEMIOLOGY
• Palilalia (repeating one’s own sound or words),
• 80% of cases of autism are early onset, with and
developmental delays starting in infancy • Echolalia (repeating the last heard sound, word, or
• Other 20% of children with autism have seemingly phrase)
normal growth and development until 2 or 3 years
of age, when developmental regression or loss of Complex Motor Tics:
abilities begins.
• Facial gestures
• Jumping, or
• Touching, or
• Smelling an object
Treatment
• Risperidone (Risperdal)
• Olanzapine (Zyprexa)
• Rest and to manage stress
2. Tourette Disorder
• Current estimates are one in 59 children in the • It involves multiple motor tics and one or more
Unites States across all ethnic, racial, and vocal tics, which occur many times a day for more
socioeconomic groups, and 1% - 2% worldwide. than 1 year,
• Autism tends to improve, in some cases • This rare disorder (4 or 5 in 10,000) is more
substantially as children start to acquire and use common in boys and is usually identified by 7
language to communicate with others. years of age.
• If behavior deteriorates in adolescence, it may
reflect the effects of hormonal changes or the 3. Chronic Motor or Tic Disorder
difficulty meeting increasingly complex social
• Chronic motor or vocal tic differs from Tourette
demands.
disorder in that either the motor or the vocal tic is
GOALS OF TREATMENT OF CHILDREN WITH AUTISM seen, but not both.
• Reduce behavioral symptoms (e.g., stereotyped • Transient tic disorder may involve single or
motor behaviors) multiple vocal or motor tics, but the occurrences
• To promote learning and development, particularly lasts no longer than 12 months.
the acquisition of language skills.
Neurodevelopmental Disorders
NCM 117/ PSYCHIATRIC NURSING/ LECTURE
4. Learning Disorders
• It is diagnosed when a child’s achievement in
reading, mathematics, or written expression is
below that expected for age, formal education,
and intelligence.
• Learning problems interfere with academic
achievement and life activities requiring reading,
math or writing.
• Reading and written expression disorders are
usually identified in the first grade, math disorder
may go undetected until the child reaches fifth
grade.
5. Motor Skills Disorders
• The essential feature of developmental
coordination disorder is impaired coordination
severe enough to interfere with academic
achievement or activities of daily living.
• This disorder becomes evident as a child attempt
to crawl or walks as an older child tries to dress
independently or manipulate toys such as building
blocks.
• Developmental coordination disorder often
coexists with a communication disorder. Its course
is variable; sometimes lack of coordination
persists into adulthood.
6. Communication Disorder
• It involves deficits in language, speech, and
communication and is diagnoses when deficits are
sufficient to hinder development, academic
achievement, or activities of daily living, including
socialization.
• Language disorder involves deficit(s) in language
production or comprehension, causing limited
vocabulary and an inability to form sentences or
have a conversation.
• Speech sound disorder is difficulty or inability to
produce intelligible speech, which precludes
effective verbal communication
• Stuttering is a disturbance of fluency and
patterning of speech with sound and syllable
repetitions.
• Social communication disorder involves the
inability to observe social “rules” of conversation,
deficits in applying context to conversation,
inability to tell a story in an understandable
manner, and inability to take turns talking and
listening with another.
7. Elimination Disorders
Encopresis
• It is the repeated passage of feces into
inappropriate places such as clothing or the floor
by a child who is at least 4 years of age either
chronologically or developmentally.
Enuresis
• Treated with Imipramine (Tofranil), an
antidepressant with a side effect of urinary
retention.
Behavioral approaches
• Pad with a warning bell
• Positive reinforcement for continence
ATTENTION DEFICIT/ HYPERACTIVITY DISORDER (ADHD)
• It is characterized by inattentiveness overactivity,
and impulsiveness.
• It is a persistent pattern of inattention and/or
hyperactivity and impulsivity more common
generally observed in children of the same age.
• Affects 5 – 8% of school – aged children, with 60
– 85% having symptoms persisting into
adolescence,
• Up to 60% continue to be symptomatic into
adulthood.
Onset and Clinical Course
• Usually identified and diagnosed when the child
begins preschool or school.
• As infants, children with ADHD are often fussy and
temperamental and have poor sleeping patterns.
• Toddlers may be described as “always on the go”
and “into everything”, at times dismantling toys
and cribs.
• They dart back and forth, jump and climb on
furniture, run through the house, and cannot
tolerate sedentary activities such as listening to
stories.
In school:
• Child fidgets constantly.
• In and out of assigned seats
• Make excessive noise by tapping or playing with
pencils or other objects
• Normal environmental noises, such as coughing,
distracts the child
• Cannot listen to directions or complete tasks
• Interrupts and blurts out answer before questions
are completed.
Etiology:
• Environmental toxins
• Prenatal influences
• Heredity
• Damage to brain structure and functions
• Prenatal exposure to alcohol, tobacco, and lead
• Severe malnutrition in early childhood increased
the likelihood of ADHD
• Brain images of people with ADHD suggest
decreased metabolism in the frontal lobes, which
are essential for attention, impulse control,
organization, and sustained goal directed activity.
• Studies have also shown decreased blood
perfusion of the frontal cortex in children with
ADHD and frontal cortical atrophy in young adults
with a history of childhood ADHD.
Treatment
1. Psychopharmacology
• Methylphenidate (Ritalin)
• Amphetamine Compound (Adderall)
• Stimulants: Dextroamphetamine (Dexedrine) and
Pemoline (Cylert)
Side effects of these drugs are insomnia, loss of appetite,
and weight loss of failure to gain weight.
Neurodevelopmental Disorders
NCM 117/ PSYCHIATRIC NURSING/ LECTURE
2. Strategies for Home and School
• Behavioral strategies are necessary to help the
child master appropriate behaviors.
• Environmental strategies at school and home
• Educating parents and helping them with
parenting strategies.
• Providing consistent rewards and consequences
for behavior, offering consistent praise, using time
– out, and giving verbal reprimands.
• Issuing daily report cards for behavior and using
point systems for positive and negative behavior.

Application of the Nursing Process

Assessment
• History
• General appearance and motor behavior
• Mood and affect
• Thought process and content
• Sensorium and intellectual processes
• Judgment and insight
• Roles and relationship
• Self – concept
• Physiological and Self – Care Considerations
Data Analysis and Planning
• Risk for injury
• Ineffective role performance
• Impaired social interaction
• Compromised family coping
Outcome Identification
• The client will be free of injury
• The client will not violate the boundaries of others.
• The client will demonstrate age-appropriate social
skills
• The client will complete tasks
• The client will follow directions
Intervention
• Ensuring Safety
• Improving role performance
• Simplifying Instructions
• Promoting a Structured Daily Routine
• Providing Client and Family Education and
Support
Evaluation
• Parents and teachers are likely to notice positive
outcomes of treatment before the child does.
• Medications are often effective in decreasing
hyperactivity and impulsivity and improving
attention relatively quickly if the child responds to
them.