week 6: neurodevelopmental disorders (Autism spectrum disorder & Attention deficit disorder)

ASD:

symptoms typically present by ________________

18 months

ASD Course:

-Early dx & tx improve __________

-Development may not be ________

-Verbal communication skills may not reflect _________ ability

-______________ are common

prognosis, linear, intellectual, comorbidities

ASD etiology-- biologic:

-______________: 22q and fragile X

-______________

-______________ (like tylenol for ex)

-______________ anything that causes decreased O2 to fetus

- no proven link to ____________

genetics, advanced parental age, prenatal exposure to toxins, perinatal complications, vaccines

ASD etiology-- Psychological:

-impaired recognition of _____________

non-verbal social cues

ASD etiology-- sociolgical:

-no proven link to ___________

parenting style

ASD core symptoms - QUALITATIVE IMPAIRMENT IN SOCIALIZATION & COMMUNICATION

deficits in ....

-_______________

-_______________ used for social interaction

-_______________, _______________, and _______________ relationships

socio-emotional reciprocity, nonverbal communicative behaviors, developing, maintaining, understanding

ASD core symptoms - _________________

-Stereotypes or repetitive motor movements, use of objects, or speech

-Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior

-Highly restricted, fixated interests that are abnormal in intensity or focus

-Hyper OR hypo reactivity to sensory input or unusual interest in sensory aspects of the environment

repetitive & restrictive behaviors

Sensory diversity in ASD-

-Apparent indifference to ____________

-Adverse response to specific ____________

-Excessive ____________ of objects

-Visual fascination with ____________

-_________ seeking behavior (ex: crashing into things, spinning)

-Preference for OR aversion to _____________

pain, sounds/noises/textures, smelling or touching, lights or movement, Sensory, touch and deep pressure

self-injurious behaviors in ASD/ID--Functions:

1

2

3

Communication of needs

Self-soothing

Escape or avoidance

self-injurious behaviors in ASD/ID-- management strategies:

1

2

3

4

5

Manipulate antecedents

Positive reinforcements

Punishment

Sensory extinction

aversive conditioning

other safety concerns in ASD:

1

2

3

4

5

Pica

Wondering

Social awareness

Aggression

Suicidal thoughts

____________ approved to tx irritability a/w autism

Atypical antipsychotics

What are 2 atypical antipsychotics that are approved to treat irritability a/w autism?

Aripiprazole and Risperidone

pharmacologic tx of ASD--

___________ and __________ (lowest dose & shortest duration necessary)

Symptom-based, least restrictive

Alternative communication strategies for ASD (4):

PECS (picture exchange communication system)

Adapted sign language

Speech-generating devices

Visual schedules

ADHD etiology---biological

1

2

3

Genetics

NT imbalance

Environmental → (prenatal exposure to tobacco, alcohol, marijuana), lead poisoning, food dyes

ADHD etiology--- psychological

1

2

Impulse control

Sensitivity to reward & punishment

ADHD etiology--- sociological

1

gender (male)

typical age onset of ADHD: ______________

at or before age 6

ADHD--

___________ tend to persist more than ___________ in adults

Inattentive symp, impulsive/hyperactive

About _______ of individuals with ADHD will have persistent impairment through adulthood

2/3

ADHD- Symp often vary across lifespan:

_________ symp typically peak in school-age & can persist throughout adolescence

Inattention

ADHD- Symp often vary across lifespan:

__________ symp typically occur 1st & decline in adolescence

hyperactive/impulsive

Inattentive ADHD Symptoms:

Often fails to give close attention to details or makes careless mistakes

Often has difficulty sustaining attention in tasks or activities

Often doesn’t seem to listen when spoken to directly

Often has difficulty organizing tasks and activities

Hyperactive/impulsive ADHD symptoms:

Often fidgets or taps hand or feet or squirms in seat

Often leaves seat in situations when remaining seated is expected

Often talks excessively

Often has difficulty waiting his/her turn

Often interrupts or intrudes on others

ADHD assessment findings in children:

__________ and ___________ difficulties

academic, social

ADHD assessment findings in adults:

1 Forgetting __________

2 Missing __________ (ex: work, bills)

3 Difficulties completing or avoidance of lengthy papers, long forms

4 Difficulties in ____________

appointments, deadlines, relationships

Safety issues in ADHD:

1 ___________→ fractures, head injury, motor vehicle accident

2 ___________ → STI, unplanned pregnancy

3. __________

4. __________

5. __________

Accidental injury, High-risk sexual behavior, Substance use, Suicide, Criminal justice involvement

Nursing interventions for ADHD:

1 Reduce ________ during task completion→ noise, electronic, social media, people

2 Allow & encourage ____________

3 Offer __________ in multiple formats

4 Break down large tasks into simple steps

5 Plan activity around typical fluctuations in attention

6 Alternate preferred & non-preferred activities

7 Make non-preferred activities more salient

8 Visual schedules/calendars & reminders

distraction, movement breaks, pt education

Non-pharmacologic tx of ADHD--

1. ____________- ex:Token economy, Differential reinforcement, Effective use of consequences

2. ____________ management training

3. ____________

4. ____________

behavior therapy, Parent behavior, Exercise, Sleep hygiene

Pharmacologic tx of ADHD

-Medication part of first-line tx = ______________

benzodiazepine

Pharmacologic tx of ADHD- Considerations when choosing medication:

1. ___________ throughout the day

2. Ability to ____________

3. Availability of ____________

4. Risk for ___________

Symptom course, swallow pills, caregiver to admin med, diversion or misuse