conditions 2

adverse childhood experiences (ACEs)

- infants and children experiencing chronic and toxic stress

- experiences can include :

` poverty

` maternal/paternal mental health disorders

` violence

` significant distributions in the caregiving experience

how to strengthen and prevent ACEs

promoting

- parental resiliency and knowledge

- social connectedness

- concrete support during times of need

- child social and emotional competence

ot with children and youth: pediatric practice

- children and youth from birth to 21 years of age

- individuals with disabilities education improvement act of 2004 (IDEA) special education services end at 21

` part c = early intervention services (infants/toddlers)

` part b = assistance for all children with disabilities (free appropriate education in least restrictive environment)

enhancing mental health in children and youth

- health promoting programs

` social and emotional learning

` positive behavioral interventions and supports

` participation in structured leisure activities

- develop and implement prevention programs

- social skills program

- play, recreation and leisure programs

what is self efficacy

belief in one's abilities and skills

outcomes of family centered care

- positive feelings of self efficacy

- satisfaction with programming, parenting behaviors, child behavior, and child functioning

- caregivers feel empowered

- allows parents to problem solve, ask questions/finding solutions, and improve quality of life

what parents want from service providers

1. true partnership

2. dependable resource for specific, objective information

3. flexibility in service delivery and communication style

4. sensitivity and responsiveness to their concerns

5. positive, optimistic attitudes

6. effectiveness in generating outcomes

strength based approach

- identify child and families strengths and not only their challenges

- focusing on strengths empowers families to see positive traits in their children and family

- empower parents by emphasizing strengths of child and using those capacities to develop strategies for promoting improved performance

family capacity building interventions

- include participatory opportunities and experiences to enhance self efficacy

- involve both practitioner led training and collaborative problem solving with parents

- train parents and caregivers on strategies and techniques to support children

- consult with families about motor, sensory, behavioral, and communication challenges

- educate caregivers on developmental milestones and play strategies

what happens when parents are more engaged in intervention

children have better outcomes

family and professional collaboration

- work together to achieve mutually agreed upon outcomes and goals that promote family competencies and support the development of the child

- may involve shifting power to client and allowing client to set the goals

- seek ongoing feedback from parents and children abouttherapy process and about the therapist's performance

- encourage parents and caregivers to use their own judgement

- empowers parents and caregivers to make decisions about child that fits their family structure and address child's needs

role of ot when working with families

- educate families on importance of early education for optimal development

- collaborate with family members considering the family life cycle

- recognize/be sensitive to family diversity like ethnicity, family structure, socioeconomic status

- follow their lead/support their effort

- design interventions that fit into daily routines

designing interventions that fit into daily efforts

1. support participation in family life

2. adaptation, resilience, and accommodation

3. self-care, health, and wellness

4. recreational and leisure pursuits

5. social participation

6. transition planning

promoting health and well-being of caregivers

- most important predictors of caregivers well being:

` child behaviors

` caregiving demands

` family function

- interventions and preventive strategies should target caregivers

features of effective interventions with families: strength based

- teach children, parents, and family members to identify strengths of child and family and to problem solve using these strengths as part of intervention

features of effective interventions with families: contextually based

- within the child's natural environment

- carried out within the typical daily routine

QUICK GUIDE TOTHE DISRUPTIVE,IMPULSE-CONTROL, ANDCONDUCTDISORDERS: conduct disorder

child patient persistently violates rules or rights of others

QUICK GUIDE TOTHE DISRUPTIVE,IMPULSE-CONTROL, ANDCONDUCTDISORDERS: conduct disorder with limited prosocial emtions

specifier for child patients whose disordered conduct is callous and disruptive, showing no remorse and no regard for the feelings of others

QUICK GUIDE TOTHE DISRUPTIVE,IMPULSE-CONTROL, ANDCONDUCTDISORDERS: oppositional defiant disorder

multiple examples of negativistic behavior persist for at least 6 months

QUICK GUIDE TOTHE DISRUPTIVE,IMPULSE-CONTROL, ANDCONDUCTDISORDERS: intermittent disorder

- with no other evident pathology these people have episodes during which they act out aggressively

- result = physically harm others or destroy property

conduct disorder: onset and specifiers

- can begin in childhood or adolescence

- specifiers identifying onset type and presence of limited prosocial emotions

conduct disorder: neurodevelopment factors

reduced gray matter in socioemotional brain regions and diminished inhibitory control are linked

conduct disorder: risk factors

- children who are highly aggressive by 8 are at risk for developing CD

- increases risk for legal and social problems

conduct disorder: etiology

arises from neurobiological vulnerabilities and adverse environmental factors affecting emotional and impulse control regions

conduct disorder: treatment approaches

- CBT

- parent training

- social skills development are primary intervention for CD

conduct disorder: impact on occupaitons

impairs

- peer relations

- emotional regulation

- participation in structured activities

- academic and social success

conduct disorder: role of OT

support emotional regulation and social participation to improve functional outcomes

oppositional defiant disorder: severity and impact

- ranges from mild to severe

- influencing relationship

- academic performance

- future mental health risks

oppositional defiant disorder: gender and development

- boys tend to show overt defiance

- girls tend to show more vernal aggression

- boys predominate 3:2

oppositional defiant disorder: biological and environmental causes

neurobiological differences and environmental factors like prenatal exposures and parenting style

oppositional defiant disorder: psychosocial treatment approaches

- psychosocial treatments like CBT

- parent management

- family therapy improves emotional regulation and behavior

oppositional defiant disorder: occupational impact

- challenges affect executive functioning and social skills

- limiting participation in school and play

oppositional defiant disorder: role of OT

promote adaptive behaviors and environmental changes to support daily functioning

Intermittent explosive disorder: age and comorbidity consideration

- diagnosis requires developmental age of 6 or older

- excludes other mental health disorders with high comorbidity rates

- comorbidities:

` ADHD

` conduct disorder

` ODD

` ASD

Intermittent explosive disorder: emotional dysregulation and impairment

characterized by poor impulse control, emotional reactivity, distress after episodes, and significant psychosocial impairment

Intermittent explosive disorder: clinical assessment and health impact

- careful diagnosis distinguishes IED from similar disorders

- links to cardiovascular risks and the need for targeted interventions

Intermittent explosive disorder: etiology

- arises from biological, psychological, and environmental factors affecting emotional regulation and impulse control

- history of childhood trauma frequently found in clients

Intermittent explosive disorder: treatment approaches

- CBT

- pharmacological treatments like SSRIs and mood stabilizers helps reduce aggressive episodes

Intermittent explosive disorder: occupational impact

affects

- work

- education

- social life due to emotional volatility and difficulty maintaining relationships

Intermittent explosive disorder: role of OT

aids in emotional regulation, trigger identification, routine structuring, and adaptive behavior training

Intermittent explosive disorder: precautions

vital to create strong boundaries and rules and to consistently adhere to them

feeding and eating disorders

- anorexia nervosa

- bulimia nervosa

- binge eating disorder

- pica

- rumination disorder

- avoidant/restrictive food intake disorder

- other specified or unspecified feeding or eating disorder

core diagnostic features of anorexia nervosa

involves energy intake restriction causing significantly low body weight and intense fear of weight gain

clinical presentations and comorbidities of anorexia

patients show behaviors like extreme dieting, excessive exercise, plus mood and anxiety comorbidities

medical complications and impact of anorexia

serious health consequences include

- bradycardia

- osteoporosis

- hormonal issues

- social and cognitive impairments

more common in females

anorexia etiology

arises from

- genetic

- prenatal

- personality

- cultural factors

` all of the above influences restrictive eating behaviors

multidisciplinary treatment for anorexia

- medical stabilization

- nutritional support

- psychotherapy

- pharmacologic management

occupational therapy impact on anorexia

disorder affects daily roles and ot aids in restoring function and healthy routines

bulimia nervosa core symptoms

binge eating episodes with compensatory behaviors like vomiting and excessive exercise

physical and mental complications of bulimia nervosa

- electrolyte imbalance

- cardiac issues

- impulsivity

- suicidal ideation

epidemiology and diagnosis challenges of bulimia nervosa

- more common in young females

- diagnosis is delayed due to normal weight and secretive symptoms

bulimia nervosa comorbidities

- anorexia, binge eating, neurological or medical conditions that may lead to bingeing must be ruled out

- borderline personality disorder

- anxiety disorder

- depression

bulimia nervosa etiology

- biological (genetics, neurotransmitter imbalances)

- psychological

- social factors

- trauma

- societal pressures

multifaceted treatment approaches for bulimia nervosa

- CBT

- dialectical behavior therapy

- medical monitoring

- pharmacological management

ot impact on bulimia nervosa

- disorder can impair work and social life

- ot aids in routine stabilization, coping skills, and role resumption

binge eating disorder characteristics

involves recurrent large food consumption with loss of control and intermittent purging

binge eating disorder psychological and physical impact

causes

- lower self esteem

- social withdrawal

- anxiety

- linked to depression and obesity related conditions

importance of early recognition of binge eating disorder

facilitates intervention to prevent serious medical complications and improve outcomes

binge eating disorder etiology facts

involves

- genetic

- neurobiological

- emotional

- environmental factors influencing behavior patterns

*most common ED

binge eating disorder therapeutic treatments

- CBT

- dialectical behavior therapy

- both help manage triggers and improve emotional regulation

binge eating disorder nutrition and medical management

nutrition counseling and medical treatment address

- hunger cues

- balanced diets

- physical health complications

binge eating disorder OT impact

affect social participation and work OT helps routine rebuilding and coping strategies

Pica

persistent ingestion of non-nutritive substances inappropriate for development and culture

pica clinical risks

ingesting non food items can cause

- choking

- poisoning

- infections

- digestive tract injuries requiring medical attention

pica diagnosis

- requires ruling out cultural practices

- differentiating from OCD, psychotic disorders, and ASD

pica importance of early education

reduce risks and support safer coping and improved daily functioning

pica etiology

arises from

- biological

- psychological

- developmental

- environmental factors including nutritional deficiencies and family stressors

pica treatment approaches

- medical management

- behavioral interventions

- psychoeducation

- sometimes pharmacologic support addressing symptoms

OT role in Pica

- help redirect sensory seeking behaviors

- establish routines

- supports families with environment adaptations

- provide opportunities for more appropriate emotional expression

pica impact on occupational engagement

- associated with intellectual or developmental disabilities

- function is impaired because of primary diagnosis

rumination disorder

repeated regurgitation of food not caused by medical conditions with symptoms like weight loss and irritability

rumination disorder complications and social impact

- malnutrition

- respiratory illness

- stigma may affect social and school participation

rumination disorder etiology

involves

- medical

- developmental

- psychosocial factors like early life stress and physical illness

rumination disorder treatment

- behavioral interventions

- diaphragmatic breathing

- caregiver training

- medical evaluation

rumination disorder OT role

supports

- feeding routines

- safe swallowing

- family education for structured mealtime environments

rumination disorder impact on daily life

affects

- nutrition

- school participation

- social engagement

- increase caregiver stress

prematurity age

- gestational age

` preterm = BEFORE 37 weeks

` EXTREMELY premature: before 28 weeks

- chronologic age is actual age since birth

- corrected age is age of infant IF born at time

prematurity birth weight

- full term in US are around 5.5 to 11 pounds

- 1500 to 2500 grams is considered low

- 1000 to 1500 grams is considered VERY low

- less then 1000 grams is EXTREMLY low

- less then 750 grams is INCREDIBELY low

complications of preterm born before 31 weeks or earlier: eyes

serial assessment of developing retinas to determine if vascularization of retinas is progressing optimally or if retinopathy of prematurity is occurring

complications of preterm born before 31 weeks or earlier: low birth weight

- significant risk of neurologic involvement like intraventricular hemorrhage

- increased risk of learning difficulties

- increased risk of cognitive delays, specific learning conditions, and language comprehension

- increased risk of problems with executive functions and behavioral problems

outcomes of nicu survivors

- 22 to 23 weeks have very low chance of survival

- with each week of gestation survival and and neurodevelopmental outcomes improve

- 34 weeks to full term who require nicu care are at higher risk of developmental delays

- late preterm infants have higher incidence of respiratory distress and vulnerabilities like hypothermia, hypoglycemia, hyperbilirubinemia, and other endocrine derangements

recent studies provide strong support for programs that emphasize these points achieve optimal effect and why OT's can make significant impact by supporting both infants and parents

- parent psychosocial and resource support

- parent participation at bedside

- parent problem solving

- parent identified goal setting

risk vs protection elements of infants

- premature birth or illness initially places infant on continuum

- level of risk increases with added risks of extremely low gestational age at birth, fetal growth restriction, and medical acuity

parent participation and making it a protective factor

- readiness to parent

- parental sensitivity to the infants behavioral communication

- parent psychological and medical wellbeing

- social supports

- provision of anticipatory guidance for the family in supporting the infant's development

the family has the greatest influences over the infant's health and wellbeing so what should happen

- included as partners in all care planning from admissions to discharge

- creating an effective partnership between professionals and families demonstrates benefits

` decreased length of stay

` enhanced neurodevelopmental outcomes for infants

` increased parent and staff satisfaction

how to increase NICU and parent collaboration

- ensuring they are welcomed

- ask questions

- demonstrate caregiving

- are listened to by the team

ot's role in nicu

- observe and assess infant's sensory responsiveness and neurobehavioral performance

- help identify infant's thresholds for sensory aspects of NICU care (positioning, handling, interaction, feeding)

- anticipating next phase in infants recovery

- provide optimal context for and support to parents and staff members in their roles as primary caregivers

multidisciplinary model for NICU care

- ot, pt, or slp obtain necessary advanced education and experience

- holistic approach to supporting infant/family role performance

neonetal ot

expected to provide

- direct patient care

- collaborative consultation with families and medical team

- staff and family support/education

- facilitation of system in NICU environment

- caregiving practices that are neuroprotective to infant and supportive of family as partners in care

early intervention programs

- part c of the individuals with disabilities act

- family centered care

- services for families when their child has established risk, developmental delay, or is at risk for developmental delays

- team approach

- Interprofessional collab

- primary service provider model

- government funding regulations

- individualized family service plan

ot in early intervention components

- screening, evaluation, and intervention

- transition to early childhood

ot in early intervention components: screening, evaluation, and intervention

systematic processes to identify needs, assess development, and implement targeted interventions

ot in early intervention components: transition to early childhood

strategies to support smooth transitions into early childhood settings, enhance continuity and stability in developmental support

ot in early intervention conclusion

- models and frameworks provide structured approach to understanding and supporting child development

- guide practitioners in designing interventions that are tailored to individuals needs of children and their families, ensuring holistic approach to developmental care

complications of prematurity

- respiratory problems

- neurological problems

- cardiovascular problems (apnea, bradycardia)

- gastrointestinal (necrotizing enterocolitis, GERD)

pediatric feeding and swallowing disorder

- reported in 10 to 25% of all children, 40 to 70% in premature infants, and 70 to 80% in children with developmental delays or cerebral palsy

` gerd

` food allergies

` oral motor function

` sensory and or behavioral issues

fetal alcohol spectrum disorder

- chronic neurodevelopmental disorder secondary to maternal alcohol consumption and or binge drinking

- physical, cognitive, and behavioral impacts that can leas to a wide variety of deficits and challenges

- significant and long lasting effects on

` iq

` learning

` memory

` executive functioning

` academic skills

neurobehavioral alcohol syndrome

- pattern of lifelong brain based impairments caused by prenatal alcohol exposure

- difficulties with

` cognition

` self-regulation

` behavior

` adaptive functioning due to alcohol's direct affects on developing fetal brain and are central to neurodevelopmental profile seen within FAS

severity of NAS is shaped by interacting maternal and environmental factors

- stress

- mental health

- smoking

- illicit drugs

- nutrition

- socioeconomic status

- genetics

*all influence how alcohol affects fetal neurodevelopment altering it's severity

symptoms that mimic other developmental conditions to NAS

- prenatal exposure to the following factors can produce neurobehavioral patterns similar to FASD

` stress

` smoking

` poor nutrition

- this makes NAS difficult to distinguish