childhood and neurodevelopmental disorders

childhood mental illness

• disruption to normal pattern of development

• barriers to assessing, diagnosing, and treating younger people

  • convincing parents to treat, hardships, concrete language

• lack of services and premature termination of treatment

effects of childhood mental illness

• long term mental disorders if not treated

• thwarted development

• diminished productivity 

• conflict within family and community

• child welfare/juvenile justice involvement

• special education resources needed

• physical health impairments

biological risk factors of childhood mental illness

• genetic predisposition

• neurobiological

psychological risk factors of childhood mental illness

• temperament

  • important in children

environmental risk factors

• abuse or trauma

• low socioeconomic status

• parenting

resiliency

• big protective factor in children

• adapt to change/adversity

• rely on inner strength

• use healthy coping strategies

• reach out for help/support

• form nurturing relationships

protective factors

• positive self image

• family cohesion/absence of discord

• positive relationship with parent/caregiver

• academic achievement

• positive peer relationships

• temperament (can be managed with parenting)

role of psychiatric mental health (PMH) nurse

• thorough assessment

• early identification

• identifying family needs

• promoting children’s rights

• avoiding seclusion and restraint

• notifying parents (have to call if there ae any changes)

interview assessment

• interaction based on developmental level

• assess interactions between child and parent

• children provide better info about internal symptoms (mood, sleep, suicide ideation)

• parents provide better info about external symptoms (behavior, relationships)

assessment process

same format as adults except:

• children need simple phases (more concrete)

• corroborate info with adult

• direct questions (not open ended)

• use play media (different from parallel)

• may not provide accurate time-line

conducting the interview: preschool children

• difficulty putting feelings into words, think concretely

• use play; conduct assessment

conducting the interview: school-aged

• able to use constructs, provide longer explanations

• establish rapport through competitive games

conducting the interviews: adolescents

• are egocentric; increased self consciousness, fear of being shamed

• tell them what info will be shared with parents; direct, candid approach

assessment includes

• family functioning: parent child relationship

• current problem: nature, severity, length; impact; triggers; behaviors at home; discipline

• history: previous treatment, family history, developmental and social

• mental status

• physical exam

developmental assessment

• intellectual thinking

• gross motor functioning

• fine motor functioning

• cognition

• thinking and perception

• social interaction and play

basic guidelines for interventions

• seek solutions, not blame

• avoid no and don’t; use do and lets do it this way

• instill hope for success by helping the child

  • learn to communicate needs early

  • manage feelings

  • learn that they are competent and worthwhile

interventions for children and adolescents

• behavioral interventions

• bibliotherapy

• expressive arts therapy

• journaling

• music therapy

• family interventions

• psychopharmacology

• disruptive behavior management

• play therapy

play therapy

• appropriate for younger children

• tool for change, expression, trust, relationship building

• creative and dynamic process; not standardized

• therapist is in role of trusted participant - not the perpetrator

neurodevelopmental disorders

• communication disorders

• motor disorders

• specific learning disorder

• intellectual developmental disorder

• autism spectrum disorders

• ADHD

communication disorders

• speech disorders

• language disorders

speech disorders

problems in making sounds

language disorders

• difficulty understanding or in using words in context and appropriately

• receptive or expressive 

• social communication disorder

motor disorders

• developmental coordination disorder

• stereotypic movement disorder

• tic disorders

developmental coordination disorder

• impairments in motor skill development

• coordination below developmental age

stereotypic movement disorder

• repetitive, purposeless movements for 4 weeks or more

tic disorders

• sudden nonrhythmic and rapid motor movements or vocalizations

3 types of tic disorders

• tourettes

• persistent motor or vocal tic disorder

• provisional tic disorder

tourettes

• most severe

• multiple motor tics and 1 or more vocal tics

• for more than 1 year

persistent motor or vocal tic disorder

• single or multiple motor or vocal tics but not both

• for more than 1 year

provisional tic disorder

• single or multiple motor or vocal tics but not both

• for less than 1 year

treating tic disorders

• behavioral techniques

• relaxation strategies

• medications: antipsychotics, clonidine, clonazepam, fluoxetine, sertraline

• deep brain stimulation

specific learning disorders

• dyslexia (reading)

• dyscalculia (math)

• dysgraphia (written expression)

intellectual development disorder

deficits in intellectual, social, and daily functioning

• early identification and intervention increases quality of life

• cognitive and social stimulation

• motivational support

recognize cues

• assess for delays (communication, self-care), neglect or abuse, social interactions

• behavioral and psychological assessment

analyze cues

what does the data reveal

prioritize hypotheses

• risk for injury

• ineffective impulse control

• impaired verbal communication

outcomes identification/generate solutions

• use spoken language

• engage in social interactions

• refrains from acting impulsively or harming self/others

implementation of plan/take action

• provide education

• support

• communication aids

• social skills

• training and therapy (individual, family, cognitive)

evaluate outcomes

• did they make progress

• does the plan need to be modified

autism spectrum disorders (ASD)

• brain based, non-progressive, pervasive

• parents first notice symptoms

  • attached to routines or objects, lack of social interaction

• emotional detachment (don’t share feelings)

• deficits in social interactions and relationships

• stereotypical repetitive speech and/or behaviors

• obsessive focus on specific objects (fixed interest)

• over adherence to routines or rituals

• hyper or hyporeactivity to sensory input

• extreme resistance to change

assessment/recognize cues

• intellectual or developmental delays

• communication, social, and behavioral skills

• parent-child relationship

• abuse

• stereotypic behavior

diagnosis/analyze cues

• multidisciplinary team

• lead and hearing screening

• ASD screening tools (CARS and M-CHAT)

outcomes identification/prioritize hypotheses

• cooperation

• consideration

• sensitivity to others

• accurately interpreting and/or exchanging messages

implementation/generate solutions/take action

• predictable and structured treatment programs

• behavior management

• parent teaching

• OT/PT speech and language therapy

• medications

  • 2nd generation antipsychotics

  • SSRIs

  • stimulants

• social skills training

evaluation

are there improvements and use of services

attention deficit hyperactivity disorder

pattern of inattention, hyperactivity, and impulsiveness that is inappropriate for developmental level

• in two or more settings: causing work, social, or educational difficulties for at least 6 months before age 12

three types of attention deficit hyperactivity disorder

• hyperactivity-impulsivity type

• inattentive type

• combined type

ADHD hyperactivity-impulsivity type

includes both hyperactivity and impulsivity behaviors

hyperactivity behaviors

• fidgets; moves feet; squirms; cant sit still

• leaves seat before excused

• runs/climbs excessively or at inappropriate times

• difficulty playing quietly

• is often on the go

• often talks excessively

impulsivity behaviors

• blurts answers before questions finished; speaks before thinking

• interrupts or intrudes others

• problem waiting their turn

ADHD inattentive type

exhibits behaviors of inattention

behaviors of inattention

• poor attention; careless mistakes

• trouble keeping on tasks or activities

• does not seem to listen when spoken to directly

• does not follow through with completion of task/activity

• trouble organizing activities

• avoids, dislikes doing tasks that involve mental effort

• loses things, distracted, or forgetful

• easily bored

• disorganized

ADHD combined type

combination of hyperactive, impulsive, and inattentive

ADHD treatment

emphasizes self regulation, social functioning, concentration, attention and focus

• behavioral management + FDA approved meds = best results

• parent management training (PMT)

• increasing problem solving skills and coping mechanisms

• group therapy: 8-12 weekly sessions to aid in behavior changes at home and in school

• pharmacological therapy

  • stimulants

  • nonstimulants

stimulants

• improve attention and focus

• decrease hyperactivity

• begin at low dose and work way up

• not weight dependent

• long-acting stimulants have a duration of 8-12 hours and can be used just once a day

long-acting stimulants

• dextroamphetamine/amphetamine (adderall XR)

• lisdexamfetamine (Vyvanse)

• methylphenidate (Daytrana, Metadate CD, Ritalin LA, Concerta)

intermediate acting stimulants

• dextroamphetamine (adderall, dexedrine)

• methylphenidate (ritalin SR, methylin ER, metadate ER)

short-acting stimulants

• methylphenidate (ritalin)

• dexmethylphenidate (focalin)

• dextroamphetamine (dexedrine)

• amphetmaine sulfate (evekeo)

side effects of stimulant medications

• decreased appetite, headaches, stomachaches, trouble getting to sleep, jitteriness, and social withdrawal

• nervousness, overstimulation, tachycardia or bradycardia, diarrhea hypertension, restlessness, insomnia, dry mouth, unpleasant taste

• can usually be managed by adjusting dosage or when med is given

• child appears dull or overly restricted (treat by decreasing dose or changing medication)

adderall XR (dexoamphetamine/amphetamine)

approved for use in children over the age of 6; capsule can be opened and sprinkled onto applesauce it can’t take pill

daytrana (methylphenidate)

• may cause permanent skin color changes

• available in patch form

• worn about 9 hours on childs hip, continues to work for a few more hours once removed

• benefit; flexibility in amount of time worn and therefore dose

methylin

comes in chewable tablet and oral solution

ritalin LA (methylphenidate)

unlike other long-acting forms of methylphenidate, capsules can be opened and sprinkled on food

concerta

• only approved for children over the age of 6

non-stimulants

• atomexitine (SNRI)

• bupropion (NDRI)

• clonidine (beta blocker)

• guanfacine (antiadrenergic agent)

• imipramine (TCA)

atomexitine

• not used as often as stimulant, slow therapeutic response

• used for children > 6 yrs, especially for children with ADHD and anxiety

clonidine

used alone or in combination with stimulation; especially good if tics present with ADHD

clonidine side effects

• dizziness

• dry mouth

• mild sedation

• constipation

• usually resolce after several doses

bupropion side effects

• dry mouth

• dizziness

• nausea

• appetite changes

• stomach pain

• headache

• ringing in ears

• sore throat

• muscle pain

atomexitine side effects

• dry mouth

• dizziness

• N/V

• decreased appetite

• trouble sleeping

• observe closely for SI

tips to help stay organized and follow directions

• schedule

• organize everyday items ; have place for everything and keep everything in its place

• use homework and notebook organizers

• be specific, clear, and consistent 

• give praise or rewards when rules are follows

• set and reward small attainable goals