Peds Exam 3: Children with Developmental Condition or Mental Health Disorder

autism spectrum disorder
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Terms in this set (46)
autism spectrum disorder
o A developmental conditions associated with significant social, communication, and behavioral challenges
Spectrum of severity and impact
when is autism spectrum disorder usually diagnosed
Usually diagnosed in early childhood/preschool age
is the prevalence of autism spectrum disorder increasing or decreasing
hard to determine:
-there is greater surveillance, more recommendations for regular early screening, better screening and eval tools, greater public awareness and acceptance
what does autism spectrum disorder include
includes autistic disorder, Asperger syndrome, pervasive developmental disorder
what percentage of children with autism spectrum disorder have a co-occuring intellectual disability
50%
what other chronic health conditions is autism spectrum disorder associated with
-seizure disorder
-sleep disorders
-GI disorders
-Allergies and immune disorders
-asthma
-mental health disorders (ADHD, anxiety, depression)
-Hypertension and diabetes in adults
What causes Autism Spectrum Disorder?
"Vaccine theory" in 1998 linking autism with the MMR vaccine
· No evidence to link this theory

Exact cause is unknown likely an interaction between environment, biological, and genetic factors
s/s on assessment of child with autism spectrum disorder
-unusual behavior (such as repetitive hand gestures)
-extreme reactions to changes in routine
-abnormal responses to sensory stimuli
-Inappropriate or decreased emotional expression
-communication difficulty (echolalia or repetition of words or phrases)
-Attachment to odd objects
-mood liability
-may have giftedness
Family and child impact of ASD:
-Trouble finding childcare/ respite care
-concerns for wellbeing of their other children
-child's ability to live independently as an adult
-marital and financial stress
-school success problems
-child's self esteem
-being bullied, isolation
applied behavior analysis
· Intensive therapy to assist with communication, self-care and ADLS, increase academic skills, decrease challenging behaviors for children with autism spectrum disorder
Interventions for children with autism spectrum disorder-Applied behavior analysis -Sensory integration therapy -Communication assists -Medications -CAMSare medications always a good therapy for children with autism spectrum disorderCan sometimes be used to modify difficult symptoms, but all have risk of adverse effects and need medical follow up to monitorwhat are some common side effects of medications used to treat ASDo Anxiety o Depression o Obsessive behavior o Seizures o Impulsivity and hyperactivity o Severe behavior problemswhat is the evidence regarding CAMS and autismgetWhat are some nursing care implications when working with children with autism- Children and young adults with ASD have higher utilization for health care services - The expression of ASD is a spectrum, each child is unique - The need for support services may be unmet or only partially met - Many Barriers to adequate carewhat are some barriers to care for children with autismwaitlist, lack of resources, unrecognized needs, access to careInterventions of autistic children· Screening and referral · Listen/validate parents and child concerns · Be an advocate · Ask what works for them, and what they need help with · Incorporate routines, consistency, soothing objects Help identify community resources and support groupsAttention Deficit Hyperactivity Disorder- Persistent pattern of inattention and/or hyperactivity/impulsivity that interferes with functioning or development - Present before age 12 - Causes impairment in at least two settingstypes of ADHDinattentive and hyperactive-impulsives/s of inattention type ADHD- Careless or disregards details - Difficulty staying focused on task - Doesn't seem to listen - Fails to finish task - Difficulty organizing - Distracted easily Forgetfuls/s of hyperactivity and impulsivity type ADHD- Fidgety or squirmy - Ignores direction to remain seated - Excessive talking - Trouble taking turns - Interrupts or intrudes on conversation - Seems to not think about behavioral consequenceswhat causes ADHD-Genetic link (4x more likely to have relative with ADHD) -Sex difference? -Enviornmental: premie, low birth weight, lead exposure -Home environment -Structural brain abnormalities may be presentdescribe the prevalence of ADHD - describe the reasoningIncidence is increasing HOWEVER: this could be due to: -diagnostic criteria changes -increased awareness -increased availability of screening -increased medications and marketing -greater acceptance of ADHD diagnosisHow does ADHD affect children?-Intelligence usually unaffected -learning difficulties and testing difficulties -lower self-esteem -difficulty making social connections/ friends -long term consequences in mental healthhow does ADHD impact a family- Behavior problems cause family and marital stress - Stress with school expectations - Parents may also have ADHD - Financial concernsfirst line interventions for children with ADHDparent skills trainingdescribe aspects of parent skills training for children with ADHD- Provide positive attention - Give effective instructions - Praise your child's efforts - Establish rewards - Use consistent consequencesdescribe medication therapy for children with ADHDStimulants (70-80% have good response) Non-stimulantsStimulants as a treatment for ADHD- Include methylphenidate and amphetamine - Stimulates dopamine receptors, increasing attentionside effects of stimulants- Side effects: insomnia, anorexia, slowed linear growth Potential for abuse by others - Caution in children with heart diseaseother than stimulants, which medications can be used to treat ADHDnon-stimulants including SNRI, alpha adrenergic agonists =strengthen the actions of pre-frontal cortexschool based interventions for children with ADHDStudents with ADHD are eligible for services and accommodations under Individuals with Disabilities Education Act - should have an individualized education planIndividualized Education Plan for children with ADHD· Multidisciplinary assessment and plan, based on child's functional strengths and limitations · Accommodations to facilitate learning and school success · Parents participate, approve goals and planNursing implications for children with ADHD- Support child self-esteem and confidence - Family/parent support (support groups, MH resources, positive parenting) - Medication monitoringanorexia nervosa BMIBMI under 17.5 kg.m2anorexia nervosa defined + 3 featuresIntense fear of gaining weight or becoming overweight (despite being underweight) Three features: - Significant self-induced starvation - Intense desire for being thin - Medical consequences of starvationrisk factors for anorexiao Sex differences in incidence o Usually presents at puberty or adolescence o Youth who identify as LGBTQ o Family history of anorexia o Social stressors o Abuse or trauma o "overachiever" academic or sports May supplement self-starvation with purging or exercisephysical effects of anorexia nervosao Bradycardia, hypotension o Hypothermic o Anemia, elevated liver enzymes, dehydration o Dry and or jaundiced skin, hair loss o Hypothyroidism o Osteoporosis o Amenorrhea o Emaciation, loss of body fat Can be fatalBulimia nervosa- Recurrant, episodic binge eating, followed by purging - Aware that this behavior is not normal, but unable to control it. Guilt and depression commoneffects of bulimiaVomiting and use of laxatives/diuretics can lead to physical consequences such as electrolyte abnormalities, esophageal tear, tooth erosion, cardiac arrythmiascomponents of treating an eating disorder-need multidisciplinary team -hospitalization sometimes necessary -medication to treat co-occurring depression and anxiety -psychotherapy -dietary rehab **relapse frequents/s depression- Loss of interest or pleasure - Significant weight change - Depressed mood - Insomnia/polysomnia - Agitation - Feeling of worthlessness and guilt - Thoughts of death - Suicidal ideation **For 2 weeks or longerwhat is the number one risk factor for depressionfamily historywhat other disorders are commonly associate with depression- ASD, ADHD, eating disorders, chronic medical conditionswho should be screened for depressionall teenswhat treatment is available for children with depression- Individual and family counseling - Medications - Family support very important - Exercise may be helpful - Close assessment of suicidality risk ... may increase as depression worsens or starts to lift