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Chapter 22 ADHD and Autism
Terms in this set (42)
______ is the DSM-5 diagnosis that includes disorders previously categorized as different types of a pervasive developmental disorder (PDD), characterized by pervasive and usually severe impairment of reciprocal social interaction skills, communication deviance, and restricted stereotypical behavioral patterns.
Autism spectrum disorder (ASD)
______ is an orderly pattern of changes in structure, thoughts, feelings, or behaviors resulting from maturation, experiences, and learning.
______ is a dynamic and continuous process as one proceeds through life, characterized by a series of ascents, plateaus, and declines.
ASD, formerly called autistic disorder, or just autism, is almost five times more prevalent in boys than in girls, and it is usually identified by 18 months and no later than 3 years of age.
The behaviors and difficulties experienced vary along the continuum from mild to severe. Children with ASD have persistent deficits in communication and social interaction accompanied by restricted, stereotyped patterns of behavior and interests/activities.
These children may display little eye contact with and make few facial expressions toward others; they use limited gestures to communicate. They can have limited capacity to relate to peers or parents. They may lack spontaneous enjoyment, express no moods or emotional affect, and may not engage in play or make-believe with toys.
There can be little intelligible speech. These children engage in _______ behaviors, such as hand flapping, body twisting, or head banging
Behaviors Common with ______
•Not responding to own name by 1 year (e.g., appears not to hear)
•Doesn't show interest by pointing to objects or people by 14 months of age
•Doesn't play pretend games by 18 months of age
•Avoids eye contact, Prefers to be alone, Delayed speech and language skills
•Obsessive interests (e.g., gets stuck on an idea)
•Upset by minor changes in routine, Repeats words or phrases over and over
Flaps hands, or rocks or spins in a circle; answers are unrelated to questions
•Unusual reactions to sounds, smells, or other sensory experiences
Autism Spectrum Disorder
Autism does have a genetic link; many children with autism have a relative with autism or autistic traits
Controversy continues about whether measles, mumps, and rubella (MMR) ______ contribute to the development of late- or regressive-onset autism.
The National Institute of Child Health and Human Development, Centers for Disease Control and Prevention, and the Academy of Pediatrics have all conducted research studies for several years and have concluded that there is no relationship between _____ and autism and that the MMR _____ is safe.
Autism tends to improve, in some cases substantially, as children start to acquire and use language to communicate with others. If behavior deteriorates in adolescence, it may reflect the effects of hormonal changes or the difficulty meeting increasingly complex social demands.
ASD, formerly called autistic disorder, or just autism, is almost five times more prevalent in ______ than in girls, and it is usually identified by 18 months and no later than 3 years of age. The behaviors and difficulties experienced vary along the continuum from mild to severe.
Autistic traits persist into adulthood, and most people with autism remain dependent to some degree on others.
Current research estimates that 20% of adults with ASD achieve most independent living outcomes, while 46% require substantial levels of support in most independent living outcomes. Many continue to live with parents or adult relatives.
The ______ is an assessment tool that can be used for initial evaluation in many areas of concern such as ADHD
SNAP-IV Teacher and Parent Rating Scale
_____ Pervasive, usually severe impairment of reciprocal social interaction skills, communication deviance, restricted stereotypical behavioral patterns
_____ There is a great deal of difference ranging from mild to severe behaviors and limitations.
Autism spectrum disorders
Autism spectrum disorders
•Pervasive developmental disorder (PDD)
•Childhood disintegrative disorder
•Asperger's disorder-no language or cognitive delays; motor clumsiness is common
Goals of Autism spectrum disorders: reduce ______ and promote ______
reduce behavioral symptoms,
promote learning and development
Interventions of Autism spectrum disorders: ______, ______, and ______
medications for target symptoms
For patients with ASD nurses should
Recognize own beliefs about parenting, how they differ from others.
Focus on child's and parents' strengths, not just problems.
Try to have positive impact on child even when disability is severe.
_______ disorder is characterized by inattentiveness, overactivity, and impulsiveness.
_______ disorder is a common disorder, especially in boys, and probably accounts for more child mental health referrals than any other single disorder.
The essential feature of ______ disorder is a persistent pattern of inattention and/or hyperactivity and impulsivity more common than generally observed in children of the same age.
Attention-deficit/hyperactivity disorder (ADHD)
Attention-deficit/hyperactivity disorder (ADHD)
Attention-deficit/hyperactivity disorder (ADHD)
To avoid overdiagnosis of ADHD, a qualified specialist, such as a _____ or _______, must conduct the evaluation for ADHD.
Children who are very active or hard to handle in the classroom can be diagnosed and treated mistakenly for ADHD. Some of these overly active children may suffer from psychosocial stressors at home, inadequate parenting, or other psychiatric disorders.
A key feature of ADHD is the consistency of the child's behavior—every day, in almost all situations, and with almost all caregivers, the child demonstrates the ______.
Distinguishing bipolar disorder from ADHD can be difficult but is crucial to prescribe the most effective treatment.
______ disorder is usually identified and diagnosed when the child begins preschool or school, though many parents report problems from a much younger age.
As infants, children with ______ disorder 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.
children with ______ disorder dart back and forth, jump and climb on furniture, run through the house, and cannot tolerate sedentary activities such as listening to stories. At this point in a child's development, it can be difficult for parents to distinguish normal active behavior from excessive hyperactive behavior.
By the time the child starts school, symptoms of ______ disorder begin to interfere significantly with behavior and performance. The child fidgets constantly, is in and out of assigned seats, and makes excessive noise by tapping or playing with pencils or other objects.
Normal environmental noises, such as someone coughing, distract the child. He or she cannot listen to directions or complete tasks. The child interrupts and blurts out answers before questions are completed.
Academic performance suffers because the child makes hurried, careless mistakes in schoolwork, often loses or forgets homework assignments, and fails to follow directions
Socially, peers may ostracize or even ridicule the child for his or her behavior. Forming positive peer relationships is difficult because the child cannot play cooperatively or take turns and constantly interrupts others.
Studies have shown that both teachers and peers perceive children with ______ disorder as more aggressive, bossier, and less likable. This perception results from the child's impulsivity, inability to share or take turns, tendency to interrupt, and failure to listen to and follow directions.
Thus, peers and teachers may exclude the child from activities and play, may refuse to socialize with the child, and/or may respond to the child in a harsh, punitive, or rejecting manner.
ADHD Definitive cause unknown: possible cortical-arousal, information-processing, maturational abnormalities in the brain
ADHD theories of combined factors: environmental toxins, prenatal influences, heredity/genetic link, damage to brain structure and functions
Brain images of ADHD suggest decreased metabolism in ______ lobes responsible for attention, impulse control, organization, and sustained goal-directed activity
There seems to be a genetic link for ADHD that is most likely associated with abnormalities in ______ and, possibly, ______ metabolism.
Having a first-degree relative with ADHD increases the risk of the disorder by four to five times more than that of the general population
Despite the strong evidence supporting a genetic contribution, there are also sporadic cases of ADHD with no family history of ADHD; this furthers the theory of multiple contributing factors.
_______ factors for ADHD include
family history of ADHD
male relatives with antisocial personality disorder or alcoholism;
female relatives with somatization disorder;
lower socioeconomic status and male gender;
marital or family discord, including divorce, neglect, abuse, or parental deprivation;
low birth weight and various kinds of brain insult
reducing ______ and ______
increasing child's _______ so they can grow and develop normally
hyperactivity and impulsivity,
ADHD nursing interventions:
•Home and school strategies
•Behavioral and Environmental strategies
•Rewards and consequences, consistent praise, time-out, verbal reprimands
•Daily report cards, point systems
•Therapeutic and creative ______
_______ is effective in 70% to 80% of children with ADHD; it reduces hyperactivity, impulsivity, and mood lability and helps the child pay attention more appropriately.
Methylphenidate and amphetamine compounds are also available in a sustained-release form taken once daily; this eliminates the need for additional doses when the child is at school.
Methylphenidate is also available in a daily transdermal patch, marketed as ______.
_______ is the only nonstimulant drug specifically developed and tested by the U.S. Food and Drug Administration for the treatment of ADHD.
_______ is an antidepressant, specifically a selective norepinephrine reuptake inhibitor.
The most common side effects of atomoxetine in children during clinical trials were decreased appetite, nausea, vomiting, tiredness, and upset stomach.
In adults atomoxetine, side effects were similar to those of other antidepressants, including insomnia, dry mouth, urinary retention, decreased appetite, nausea, vomiting, dizziness, and sexual side effects.
In addition, atomoxetine can cause _____ damage, so individuals taking the drug need to have _____ function tests periodically
Methylphenidate (Ritalin) Monitor for ______ suppression or growth delays.
Amphetamine (Adderall) Monitor for ______.
Lisdexamfetamine (Vyvanse) Monitor for ______.
Atomoxetine (Strattera) Give with _____. Monitor for ______ suppression. Use ______ beverages to relieve dry mouth. Monitor for elevated ______ function.
Clonidine (Kapvay) and Guanfacine (Intuniv)
Monitor for ______, dizziness, syncope, somnolence.
Use _______ beverages to relieve dry mouth.
In _____ play, play techniques are used to understand the child's thoughts and feelings and to promote communication.
This should not be confused with play ______, a psychoanalytic technique used by psychiatrists.
_______ play is acting out an anxiety-producing situation such as allowing the child to be a doctor or use a stethoscope or other equipment to take care of a patient (a doll). Play techniques to release energy could include pounding pegs, running, or working with modeling clay.
_______ play techniques can help children to express themselves; for example, by drawing pictures of themselves, their family, and peers. These techniques are especially useful when children are unable or unwilling express themselves verbally.
During ADHD assessment, the nurse gathers information through direct observation and from the child's parents, day care providers, and teachers.
Assessing the child in a group of ______ is likely to yield useful information because the child's behavior may be subdued or different in a focused one-to-one interaction with the nurse.
It is often helpful to use a checklist when talking with parents to help focus their input on the target symptoms or behaviors their child exhibits.
•History: _____ as infant, "out of control", difficulties in all major life areas,
•General appearance and motor behavior: inability to _____ still, inability to carry on conversation, abrupt jumping from topic to topic, interrupts and blurts out answers
•Mood and affect: possibly labile, anxiety, frustration, ______
•Thought process and content: generally no impairments, may be difficult to assess
•Sensorium and intellectual processes: impaired ability to pay ______ or _____
•Judgment and insight: poor; no thinking before action
•Self-concept: ______ self-esteem
•Roles and relationships: academic, social problems
•Physiologic and self-care: sleeping, eating, risk taking behaviors- there may be a history of physical injuries
Nursing diagnoses commonly used when working with children with ADHD include:
•Risk for _____
•Ineffective _____ performance
•Impaired ______ interaction
•Compromised _____ coping
Treatment outcomes for clients with ADHD may include:
•The client will be free of ______.
•The client will not violate the _____ of others.
•The client will demonstrate age-appropriate ______ skills.
•The client will complete ______.
•The client will follow _______.
•Improving _____ performance
•Promoting a structured daily ______
•Providing client and family ______ and ______
education and support
______ and ______ 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.
Improved sociability, peer relationships, and academic achievement happen more slowly and gradually but are possible with effective treatment.
Parents and teachers
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