Neurodevelopmental Disorders

What defines neurodevelopmental disorders?

Usually diagnosed in infancy, childhood, or adolescence, with constant developmental changes, limited abstract cognitive abilities, and possible mood, anxiety, or eating disorders

Which disorders are included under neurodevelopmental disorders?

Autism spectrum disorder, ADHD, Tourette disorder, separation anxiety disorder, obsessive-compulsive disorder, and related childhood disorders

What behaviors characterize autism spectrum disorder?

Severe impairment in social interaction, communication deviance, restricted/stereotypical behavioral patterns

Which previous diagnoses are now considered part of the autism spectrum?

Pervasive Developmental Disorders (PDDs)

What is the range of behaviors in autism spectrum disorder?

Behaviors range from mild to severe with varying limitations

At what age does autism typically present?

Early childhood, usually between 18 months and 3 years

Which gender is more commonly affected by autism?

Boys

What are signs of autism related to eye contact and facial expression?

Little eye contact and few facial expressions

What are signs of autism related to gestures?

Limited gestures to communicate

What are signs of autism in peer or parent interactions?

Limited capacity to relate to peers or parents

What signs of autism indicate lack of enjoyment or affect?

Lack of spontaneous enjoyment and express no moods or emotional affect

What signs of autism are related to play?

Inability to engage in play or make-believe with toys

What are speech-related signs of autism?

Little intelligible speech

What are motor behavior signs of autism?

Stereotyped motor behaviors

What is known about autism etiology?

Genetic link, no relationship to MMR vaccine, traits persist into adulthood

How can autism traits change over time?

Traits may improve with acquisition and use of language

What are the treatment goals for autism?

Reduce behavioral symptoms and promote learning and development

What is Applied Behavior Analysis (ABA)?

Child learns positive behaviors and reduces negative behaviors through structured reinforcement

What is Verbal Behavior Intervention (VBI)?

Focuses on improving language skills in children with autism

What is TEACCH?

Uses visual cues, such as picture cards, to help children learn everyday skills like getting dressed

Which medications are FDA-approved for autism-related irritability?

Risperidone and Aripiprazole (Abilify)

What defines Tourette disorder?

Multiple motor tics and one or more vocal tics

What is known about Tourette disorder etiology?

Genetic involvement

At what age do tics typically appear in Tourette disorder?

Between 2 and 15 years, average around 6 years

Which gender is most affected by Tourette disorder?

Males are about 3–4 times more likely than females

What happens to tics after adolescence in Tourette disorder?

Tics often lessen or become controlled

Which medications are FDA-approved for Tourette disorder?

Haloperidol (Haldol), Pimozide (Orap), Aripiprazole (Abilify)

Which medications are used off-label for Tourette disorder?

Alpha-adrenergic agonists such as clonidine and guanfacine

Which non-pharmacologic therapy is used for Tourette disorder?

Psychotherapy

What defines separation anxiety disorder?

Developmentally inappropriate fear or anxiety about harm to or permanent loss of major attachment figure

What is a common manifestation of separation anxiety disorder?

School phobia

At what age does separation anxiety disorder usually occur?

Mean age of 7 years

What are risk factors for separation anxiety disorder?

Parental anxiety or parental depression in one or both parents

Which behaviors define obsessive-compulsive disorder (OCD) in children?

Intrusive thoughts (obsessions) and ritualized behaviors (compulsions)

What treatments are used for childhood OCD?

Cognitive-behavioral therapy, psychoeducation, cognitive training, and SSRIs

What is included in nursing management for childhood OCD?

Distinguishing between normal and pathologic behaviors, administering antidepressants, and close monitoring (black box warning)

Which mood disorder accounts for the largest percentage in children?

Depression

How do children with depression often express suffering?

Through behavior rather than verbal expression of feelings

Which medications are used for childhood depression?

Antidepressants (SSRIs), requiring frequent monitoring

Which medications are used for childhood bipolar disorder?

Mood stabilizers or antipsychotics

How is childhood schizophrenia diagnosed?

By the same criteria used in adults

What is characteristic of premorbid functioning in childhood schizophrenia?

Poorer functioning compared to adult-onset schizophrenia

Which treatments are used for childhood schizophrenia?

Antipsychotics for symptoms, parent education, long-term management

Which behaviors define ADHD in children?

Inattentiveness, overactivity, impulsiveness, fidgeting, noisy, disruptive, inability to complete tasks, failure to follow directions, blurting out answers, lost or forgotten homework, possible ostracism by peers

When is ADHD often diagnosed?

When the child starts school

What etiologies are proposed for ADHD?

Possible cortical-arousal, information-processing, or maturational abnormalities in the brain

What are the goals of ADHD management?

Managing symptoms, reducing hyperactivity and impulsivity, increasing attention

Which interventions are used for ADHD?

Combination of medications, behavioral, psychosocial, and educational interventions

Which home/school strategies support ADHD management?

Consistent rewards and consequences, therapeutic play

Which findings in history suggest ADHD?

Fussy as infant, “out of control”, difficulties in all major life areas

What general appearance and motor behaviors suggest ADHD?

Inability to sit still, inability to carry on conversation, abrupt jumping from topic to topic

What mood and affect signs suggest ADHD?

Possibly labile, anxiety, frustration, agitation

What thought process and content signs suggest ADHD?

Impulsivity and difficulty sustaining attention

What sensorium and intellectual processes signs suggest ADHD?

Impaired ability to pay attention or concentrate

What judgment and insight signs suggest ADHD?

Poor judgment, impulsive behavior

What self-concept signs suggest ADHD?

Low self-esteem, negative reactions to own behavior

What roles and relationships signs suggest ADHD?

Academic and social problems

What physiological and self-care signs suggest ADHD?

May be thin, trouble settling down, sleeping problems

What outcomes are appropriate for ADHD?

Free of injury, no violation of others’ boundaries, demonstrate age-appropriate social skills, complete tasks, follow directions

Which interventions ensure safety and behavioral support in ADHD?

Ensuring safety, improving role performance, simplifying instructions, promoting structured daily routine, providing client and family education and support

Which medications are first-line for ADHD?

Stimulants (psychostimulants)

What are adverse effects of stimulants?

Insomnia, increased heart rate, anorexia, weight loss, growth stunting, potential for abuse

Which amphetamine medications are used for ADHD?

Amphetamine/dextroamphetamine combination, Adderall, Adderall XR, Dexedrine, Lisdexamfetamine (Vyvanse)

Which methylphenidate formulations exist?

Immediate-release (Ritalin, Methylin), extended-release (Ritalin LA, Metadate ER, Ritalin SR, Methylin ER), controlled delivery (Metadate CD)

Which additional methylphenidate agents exist?

Daytrana (patch), Focalin (immediate-release), Concerta (extended-release)

When are nonstimulants indicated for ADHD?

When stimulants cannot be tolerated due to severe side effects or contraindications (psychiatric, sleep, cardiovascular, stimulant abuse history)

Which nonstimulant is administered once daily for ADHD with no abuse potential?

Atomoxetine (Strattera)

What are side effects of atomoxetine?

Insomnia, decreased appetite

Which nonstimulants are used for adjunct ADHD therapy?

Guanfacine (may decrease blood pressure, cause somnolence/fatigue), Clonidine (no anorexia/insomnia, swallow tablets whole, less effective than stimulants)

Which tool is used for early detection of ADHD symptoms?

SNAP-IV Teacher and Parent Rating Scale

Which professionals are involved in early intervention for ADHD?

School psychologist, pediatrician, physiotherapist, teacher, neurologist, family, speech therapist, occupational therapist

Which self-awareness actions should nurses take when working with children with mental health issues?

Recognize own beliefs about parenting, focus on child’s and parents’ strengths, support parents, ask parents how they are doing