Lecture 8 - Childhood and Neurodevelopmental Disorders

child psych nursing goals

• assist children to gain control of lives/resiliency building

• strengths-based approach (highlighting what child does well)

• positive psychology

• trauma-informed care

• conservation med use and promotion of coping skills over PRN meds

resiliency

the capacity to recover quickly from difficulties; adaptability

• ability to perceive long-term future

• ability to distance self from emotional chaos

• ability to form nurturing relationships with other adults when parent isn’t available

Eriksons stages of development

• early childhood → autonomy vs shame/doubt

• preschool → initiative vs guilty

• school age → industry vs inferiority

• adolescence → identity vs role confusion

• young adult → intimacy vs isolation

ASD ND

impaired social interaction r/t difficulty maintaining relationships

ADHD meds

• stimulants (controlled)

  • ritalin, concerta, adderall

• non stimulants (not controlled)

  • strattera

• alpha 2 adrenergic agonists

  • clonidine

• mood stabilizers, alpha-adrenergic agonists, antipsychotics for aggression

ASD sx

persistent deficits in social communication, social-emotional reciprocity, nonverbal communication, and maintaining/understanding relationships; restricted, repetitive patterns of behaviors, interests, or activities; clinically significant impairment in social, occupation, or other areas of functioning NOT better explained by intellectual disability

Applied Behavioral Analysis (ABA)

Psychological therapy for ASD → encourages positive behaviors and discourages negative behavior

• HEAVY family involvement

ADHD Inattention sx

** need 6+ **

fails to give close attention to details, careless mistakes, difficulty sustaining attention/organizing, doesn’t listen when spoken to directly, doesn’t follow through on instruction and fails to finish, no sustained mental effort, distraction, etc.

ADHD hyperactivity/impulsivity sx

** need 6+ **

fidgets, squirms, leaves seat/runs/climbs inappropriately, unable to engage in leisure activities quietly, “on the go”, talks excessively, blurts out answers, interrupts

hyperactivity definition

excessive physical movement and restless energy; fidgeting, talking, etc.

impulsivity definition

acting without foresight or inhibiting reactions; interruptions, impatient, etc.

Intermittent Explosive Disorder

pattern of behavioral outbursts characterized by inability to control ones aggressive impulses; goes from rage to remorse

Oppositional Defiant Disorder

oppositional behavior and contrariness exceeding what is socially acceptable; affects emotions (anger) and behaviors (defiance/arguing)

Conduct Disorder

persistent pattern in which the rights of others are violated and societal norms are disregarded; can develop into antisocial personality disorder

• pyromania: repeated and deliberate fire-setting

• kleptomania: repeated failure to resist urges to steal objects not needed for personal use or monetary value

• all have build up of tension then pleasure and relief from action

Three Levels of ASD

Level I: requiring support

• difficulty initiating social interactions

• organization and planning problems can hamper independence

Level II: requiring substantial support

• social interactions limited to narrow special interests

• frequent restricted/repetitive behaviors

Level III: requiring very substantial support

• severe deficits in verbal/nonverbal social communication skills

• great distress and difficulty changing actions or focus

types of language

receptive: ability for someone to understand and do what is being asked of them

expressive: persons ability to convey what they need through saying, writing, or pointing to it

interventions for learning needs

504: provides accommodations in general classroom setting

• ex) extra testing time, audiobook, specific seating arrangement

IEP: much more specialized and rigorous process to evaluate, formalize, and implement; involves multiple staff members

• requires more documentation and decision making from school

• tend to be for those with more complex learning and medical needs