NURS 2872 - Neurodevelopmental and Eating disorders

What are Neurodevelopmental Disorders?

Disorders with onset during childhood where initial symptoms often develop before school age. They should be screened for at all well-child pediatric visits.

When do Neurodevelopmental Disorders usually manifest?

They typically manifest before a child enters school.

What is a Developmental Delay?

A developmental change not found in an individual that can be found in 95% of others at the same chronological age range.

When should Developmental Delays be screened for?

They should be routinely screened for during well-child visits.

What is the Denver Developmental Screening Test II used for?

It screens ages 1 month to 6 years for developmental delays. Often requires further specified screening. (GIDDENS)

What is an example of a medical condition associated with a neurodevelopmental disorder?

Down Syndrome — risks include maternal age over 35 years old.

What are common impairments in Neurodevelopmental Disorders (DSM-5)?

Impairments in personal, academic, and social functioning; control of executive functions, intelligence, learning, speech, motor functioning, communication, attention, coordination, and delays in achieving expected milestones.

What are examples of “excess” symptoms in Neurodevelopmental Disorders (DSM-5)?

Repetitive behaviors, sounds, or interests; hyperactivity; impulsivity; motor or vocal tics.

What does executive functioning include?

Reasoning, problem solving, planning, abstract thinking, and judgment.

What are the DSM-5 categories of Neurodevelopmental Disorders?

Intellectual Disabilities (Mild, Moderate, Severe, Profound, Global Developmental Delay)
Communication Disorders (Language disorder, Speech sound disorder, Childhood-onset fluency disorder, Social (pragmatic) communication disorder)
Autism Spectrum Disorder
Attention Deficit/Hyperactivity Disorder
Specific Learning Disorder
Developmental Coordination Disorder
Stereotypic Movement Disorder
Tic Disorders (Tourette’s, Persistent/Chronic Motor or Vocal Tic Disorder, Provisional Tic Disorder, Other Specified Tic Disorder)

Other Specified Neurodevelopmental Disorder
What is the CDC “Act Early” program?

A program providing resources for parents about normal and abnormal developmental milestones and what to do if concerns arise.

Where can parents access the CDC “Act Early” program resources?

Website: https://www.cdc.gov/ncbddd/actearly/index.html
Video: https://youtu.be/9Ithxd5KWhw

What psychiatric disorders have potential to begin in childhood?

Intellectual Disability, Autism Spectrum Disorder (ASD), ADHD, Oppositional Defiant Disorder, Conduct Disorder, and others.
Autism Spectrum Disorder (ASD)

What are the DSM-5 criteria for Autism Spectrum Disorder?

Specific deficits in social communication and social interaction.
Restricted, repetitive patterns of behavior, interest, or activities.
Symptoms present in early development.
Significant impairment in functioning.
Not better explained by intellectual disability or global developmental delay.

What are examples of social communication and interaction deficits in ASD?

Reduced emotions or affect, failure to initiate or respond to social interactions, poor eye contact, abnormal body language, difficulty developing and maintaining relationships.

What are examples of restricted/repetitive behaviors or interests in ASD?

Stereotyped/repetitive motor behaviors (hand flapping, lining up objects), insistence on sameness, fixated interests, and abnormal sensory responses (e.g., indifference to pain, excessive smelling of objects).

What is the key to effective treatment for ASD?

Early intervention.

What are evidence-based treatments for Autism Spectrum Disorder?

Applied Behavior Analysis (ABA), Verbal Behavior Therapy, Individualized Education Program (IEP), family-focused care, parent training, and in-home therapies.

Are there any FDA-approved medications for Autism treatment?

No. Mood stabilizers or antipsychotics may be used for agitation; SSRIs/SNRIs may help with obsessive behaviors.

What are the focuses of ABA and Verbal Behavior Therapy?

Teaching children (starting around age 2) communication and social interaction through play-based methods that encourage shared attention and communication.

What is the purpose of an Individualized Education Program (IEP)?

To support children with special needs within mainstream schooling environments.

What are nursing interventions for Autism Spectrum Disorder?

Include the family in care planning.
Do not interrupt self-stimulatory behaviors unless unsafe.
Maintain a calm environment and consistent routine.
Be aware of hypersensitivity to sensory input.
Ask before touching the child.
Use calm voice, short phrases, pictures if needed.
Avoid colloquialisms; use literal, concrete language.

How does DSM-5 define ADHD?

A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.

What are symptoms of inattention in ADHD?

Careless mistakes, trouble sustaining attention, not listening, failure to finish tasks, disorganization, avoidance of sustained effort, losing necessary items, and being easily distracted.

What are symptoms of hyperactivity and impulsivity in ADHD?

Fidgeting, leaving seat, running or climbing inappropriately, inability to play quietly, excessive talking, blurting out answers, interrupting others, and difficulty waiting turns.

What are diagnostic requirements for ADHD?

6+ symptoms for at least 6 months, present before age 12, occur in 2+ settings, and interfere with quality of life.

What are treatments for ADHD (Varcarolis)?

Behavior modification therapy, parent training, school accommodations (IEP), nonstimulant medications (Guanfacine, Atomoxetine), and stimulant medications (Methylphenidate, Vyvanse, Adderall).

How is ADHD diagnosed?

May involve formal neurocognitive testing performed by a PhD-level psychologist.

What is behavior modification therapy for ADHD?

Therapy that strengthens positive behaviors and eliminates unwanted behaviors, involving training for parents, teachers, children, and families.

Are stimulants for ADHD addictive?

They can be, and may cause withdrawal if stopped abruptly — but children treated with medication are less likely to use illicit drugs later in life.

What do parents learn in behavior therapy for ADHD?

Over 8–16 sessions, parents learn strategies to help their child, practice between sessions, and often continue to experience improved behavior and reduced stress after therapy ends.

What are nursing interventions for ADHD (CDC)?

Give positive reinforcement for desired behaviors.
Allow time for movement and exercise.
Minimize distractions.
Maintain predictable routines.
Limit choices.
Use short, specific statements.
Assist with planning.
Use timeouts or removal of privileges instead of corporal punishment.
Involve the family.
Monitor height, weight, sleep, and food intake (especially on stimulants).

What are the DSM-5 categories of Disruptive, Impulse-Control, and Conduct Disorders?

Oppositional Defiant Disorder (ODD)
Intermittent Explosive Disorder (IED)
Conduct Disorder (CD)
Antisocial Personality Disorder
Pyromania
Kleptomania
Unspecified Disruptive, Impulse-Control, and Conduct Disorder

What is the defining characteristic of these disorders?

Problems in self-control of emotions and behaviors that manifest as violations of others’ rights or conflict with societal norms or authority figures.

What is a common underlying issue in these disorders?

Poor impulse control, sometimes relieved by acting on urges (e.g., firesetting in pyromania, stealing in kleptomania).

Who is most often affected by Disruptive, Impulse-Control, and Conduct Disorders?

More common in males; frequently comorbid with substance abuse and antisocial personality disorder.

What must be considered when diagnosing these disorders?

Frequency, persistence, pervasiveness across situations, and impairment must be compared to what is typical for the person’s age, gender, and culture (DSM-5 pp. 461–462).

Oppositional Defiant Disorder (ODD)
How is Oppositional Defiant Disorder characterized?

A pattern of angry/irritable mood, argumentative/defiant behavior, and vindictiveness toward people other than immediate family members, lasting 6+ months with 4+ symptoms.

What are the three symptom categories of ODD?

Angry/Irritable Mood (loses temper, easily annoyed, angry/resentful)
Argumentative/Defiant Behavior (argues with authority, refuses to comply, deliberately annoys, blames others)
Vindictiveness (spiteful or vindictive at least twice in 6 months)

How often must ODD behaviors occur for diagnosis?

Most days if the child is under 5 years old; at least once per week if older.

What is a key feature of insight in ODD?

The person has limited insight into their problem behaviors.

How is Conduct Disorder defined (DSM-5)?

Persistent/repetitive behaviors violating the rights of others or major societal norms, shown by aggression to people/animals, destruction of property, deceit/theft, or serious rule violations.

What are possible emotional features of Conduct Disorder?

Lack of remorse or guilt, lack of empathy, disregard for performance, and shallow or insincere emotions.

What behaviors differentiate ODD from Conduct Disorder?

ODD: argues with adults, loses temper, annoys others.
CD: theft, destruction, aggression, law-breaking (e.g., firesetting, using weapons, forced sexual activity).

What is the relationship between ODD and Conduct Disorder?

ODD may precede Conduct Disorder; both involve defiance and aggression but CD includes violation of others’ rights.

Which symptoms are typical of ODD vs Conduct Disorder?

Often loses temper — ODD
Fire setting — CD
Forces sexual activity — CD
Deliberately annoys others — ODD
Destroys/steals property — CD
Abuses pets — CD
Often bullies — both
Initiates fights — both
Argues with adults — ODD
Uses a weapon — CD
Disregards curfew — CD
Truant/runs away — CD

What are key treatment priorities for Disruptive, Impulse-Control, and Conduct Disorders?

Early treatment, removing child from abusive environments if needed, collaboration with law enforcement and CPS when appropriate.

Are “wilderness” programs evidence-based for conduct issues?

No — they are not supported by evidence.

Are medications approved for these disorders?

No specific FDA-approved medications, though comorbid symptoms (e.g., impulsivity, aggression, depression) may be treated with stimulants, antidepressants, lithium, clonidine, or atypical antipsychotics.

What are examples of psychosocial treatment programs?

Anger Control Training, Multidimensional Treatment Foster Care, and Positive Parenting Program (“Triple P”).

What is Anger Control Training?

A CBT-based group program (50 min, weekly) for children to learn problem solving, emotional regulation, and appropriate responses in anger-provoking situations.

What is Multidimensional Treatment Foster Care?

Alternative to institutionalization for chronic delinquency.
Youth placed in foster home 6–9 months with daily point-based token economy.
Focuses on problem solving, anger control, social skills, and educational/vocational planning.
Foster parents maintain daily contact with treatment providers; biological parents receive training for reintegration.

What is the Positive Parenting Program (“Triple P”)?

A multi-level prevention/intervention model providing parenting education through public programs, brief primary care sessions, or extended therapy depending on need (1–12 months).

What is the prognosis for Conduct Disorder?

40% of children with CD may develop Antisocial Personality Disorder in adulthood.

What are major references for treatment and evidence?

Virtual Mentor (2006, AMA Journal of Ethics), Medline Plus, Varcarolis, UCLA’s “Conduct and Behavior Problems” (2015), and Eyberg et al. (2008, Journal of Clinical Child Psychology).
Nursing Interventions for Disruptive, Impulse-Control, and Conduct Disorders

What are key nursing interventions?

Use strict limit setting.
Avoid power struggles and staff splitting.
Report suspected abuse to Child Protective Services.
Maintain predictable routines.
Encourage family involvement and education.
Teach problem solving, empathy, and impulse control.
Use PRN meds for aggression if needed.
Use seclusion/restraint only when necessary.
Provide safe environment for anger practice.
Implement token economies and therapeutic holding when appropriate.

What is the purpose of Play Therapy?

“Play is the work of childhood” (Varcarolis, p.414). It allows children to master impulses, adapt, and communicate.

What are tools used in Play Therapy?

Art supplies, toys, hand puppets, dolls, and action figures — individually or in groups — to provide insight into stressors.

Who facilitates Play Therapy in healthcare settings?

Child Life Specialists through therapeutic play.
Cognitive Behavioral Therapy (CBT)

What is CBT used for?

A therapy used to treat most psychiatric diagnoses, individually, in groups, or families, to modify negative thoughts leading to dysfunctional emotions and actions.

What is the theoretical basis of CBT?

The way a person perceives a situation influences their emotions and behaviors more than the situation itself.

What is the CBT cycle?

Situation → Automatic thoughts/images → Emotion → Behavior (cyclical pattern).

What is “reframing” in CBT?

Changing automatic thoughts to alter resulting emotions and behaviors.

What’s an example of CBT application?

Situation: Teacher didn’t call on me.
Automatic thought: “The teacher thinks I’m stupid.”
Reaction: Withdraws, stops participating.
Result: Ongoing negative emotions, decreased motivation, declining grades.

What are CBT references?

Varcarolis (2016) and Beck Institute for Cognitive Behavior Therapy (www.beckinstitute.org).

What are the DSM-5 Feeding and Eating Disorders?

Pica, Rumination Disorder, Avoidant/Restrictive Food Intake Disorder, Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder, and Unspecified Feeding or Eating Disorder.
Anorexia Nervosa

What defines Anorexia Nervosa?

Food restriction leading to significantly low body weight, intense fear of gaining weight or becoming fat, and self-evaluation overly influenced by body weight or shape.

What are the subtypes of Anorexia Nervosa?

Restricting type and Binge-eating/Purging type.

What are the BMI severity cutoffs for Anorexia Nervosa?

Mild: BMI ≥ 17; Extreme: BMI ≤ 15.
Bulimia Nervosa

How is Bulimia Nervosa defined (DSM-5)?

Recurrent episodes of binge eating and compensatory behaviors (e.g., purging) occurring at least once per week for 3+ months, with self-evaluation unduly influenced by body weight or shape.

What is binge eating?

Eating an amount of food larger than most would eat in a similar period (2 hours or less) while feeling a lack of control over eating.

What are examples of purging or compensatory behaviors in Bulimia Nervosa?

Vomiting, laxative or diuretic use, excessive exercise, fasting, stimulant/diet pill abuse, or insulin/thyroid medication misuse.

Does Bulimia Nervosa occur exclusively during Anorexia Nervosa?

No — it occurs independently.
Treatment of Feeding and Eating Disorders (NEDA)

What kind of team is needed for treatment?

A multidisciplinary team: therapist, psychiatric prescriber, nutritionist, and sometimes a medical prescriber depending on severity.

What are key therapeutic approaches for eating disorders?

Individual, group, and family therapy; Dialectical Behavioral Therapy (DBT); Cognitive Behavioral Therapy (CBT); and, for severe cases, residential or inpatient treatment.

What are important facts about treatment outcomes?

Anorexia Nervosa has the highest death rate of all mental illnesses.

How effective are medications for eating disorders?

Limited unless combined with therapy and nutritional counseling. FDA-approved medications: Fluoxetine (for Bulimia Nervosa) and Vyvanse (for Binge-Eating Disorder).

What is the link for screening tools from NEDA?

https://www.nationaleatingdisorders.org/screening-tool
What is the treatment resource link from NEDA?

What are common medical complications to monitor?

Metabolic and electrolyte disturbances, rapid weight changes, GI issues, amenorrhea, syncope, bradycardia, hypotension, sick euthyroid, anemia, osteopenia, fractures, and psychiatric comorbidities.

What are key nursing responsibilities for eating disorder patients?

Notify prescriber if concerns arise.
Model balanced relationships with food, weight, and exercise.
Monitor vital signs and labs frequently.
Conduct daily blind weights (do not disclose weight or BMI).
Avoid discussions about food, weight, or appearance.
Use distraction techniques before, during, and after meals.
Avoid assumptions based on appearance, weight, gender, or sexual preference.