Chapter 11: childhood & neurodevelopmental disorders

Which factor can reduce the vulnerability of a child to etiological influences predisposing to the development of psychopathology?

Resilience

Malnutrition

Child abuse

Having a depressed parent

RESILIENCE

- Refers to developing and using certain characteristics that help a child to handle the stresses of a difficult childhood without developing mental problems

- Resilient children can adapt to changes in the environment, form nurturing relationships with adults other than their parents, distance themselves from the emotional chaos of the family, and have social intelligence and the ability to use problem-solving skills

When a nurse assesses the style of behavior a child habitually uses to cope with the demands and expectations of the environment, he or she is assessing what characteristic?

Temperament

Resilience

Vulnerability

Cultural assimilation

TEMPERAMENT

- May be modified by the parent-child relationship

A child diagnosed with autism will demonstrate impaired development in which area?

Adhering to routines

playing with other children

swallowing and chewing

eye-hand coordination

PLAYING WITH OTHER CHILDREN

- Autism affects the normal development of the brain in social interaction and communication skills. Sx associated with autism spectrum disorders

o Significant deficits in social relatedness, including communication, nonverbal behavior, and age-appropriate interaction

o Other behaviors include

stereotypical repetitive speech

obsessive focus on specific objects

over adherence to routines or rituals

hyper or hypo reactivity to sensory input

extreme resistance to change

A 5 year old who consistently omits the sound for "r" and "s" when speaking is demonstrating which type of disorder?

Speech

Language

Social communication

Specific learning

SPEECH

- speech disorders are marked by problems in making sounds. Children may have trouble making certain sounds, or may distort, add, or omit sounds

which nursing diagnosis should be considered for a child with attention deficit hyperactivity disorder ADHD?

Anxiety

risk for injury

defensive coping

impaired verbal communication

RISK FOR INJURY

- marker hyperactivity puts him or her at risk for injury from falls, bumping into objects, impulsively operating equipment, pulling heavy objects off shelves, etc

When a child demonstrates a temperament that prompts the mother to say, "she is just so different from me; I just can't seem to connect with her." The nurse should plan to provide what intervention:

Suggest that the child's father become her primary caregiver.

Encourage the mother to consider attending parenting classes.

Counsel the mother regarding ways to better bond with her child.

Educate the father regarding signs that the child is being physically abused.

COUNSEL THE MOTHER REGARDING WAYS TO BETTER BOND WITH HER CHILD

- all people have temperaments, and the fit between the child and parent's temperatment is critical to the child's development. The caregiver's role in shaping that relationship is of primary importance, and the nurse can intervene to teach parents ways to modify their behaviors to improve the interaction

which social behavior is often a result of a child having been exposed to some form of abuse?

Speech disorders

Bullying others

Eating disorders

Delayed motor skills

BULLYING OTHERS

- children who experienced abuse are at risk for identifying with their aggressor and may act out, bully others, become abusers, or develop dysfunctional interpersonal relationships in adulthood.

A 7 year old, who is described as impulsive & hyperactive, tells the nurse, "I am a dummy, because I don't pay attention, and I can't read like the other kids." The nurse notes that these behaviors are most consistent with which diagnosis?

Attention deficit disorder

Attention deficit hyperactivity disorder

Autism

Conduct disorder

ADHD

Which behavior is most indicative of a 4 year old child diagnosed with Tourette's syndrome?

Difficulty in social relationships

Humming while performing activities that require concentration

Frequent eye blinking

Difficulty in completing tasks on time

FREQUENT EYE BLINKING

- persistent motor or vocal ticking is characteristic

A child diagnosed with ADHD is reprimanded for taking the nurse's pen without asking first. He responds by shouting, "you don't like me! You wont let me have anything, even a pen!" the nurse is most therapeutic when responding by saying:

"I do like you, but I don't like it when you grab my pen."

"Liking you has nothing to do with whether I will loan you my pen."

"It sounds as though you are feeling helpless and insecure."

"You must ask for permission before taking someone else's things."

: I DO LIKE YOU, BUT I DON'T LIKE IT WHEN YOU GRAB MY PEN

- this statement shows positive regard while describing behavior as undesireable. This helps the child feel accepted while making her ware of the effect her behavior has on others

A 10 year old who is frequently disruptive in the classroom begins to fidget and then moves on to disruptive behavior. What is the most appropriate initial technique for managing this sort of disruptive behavior?

Therapeutic holding

Seclusion

Quiet room

Touch control

TOUCH CONTROL

- the appropriate adult can move closer to the child and place a hand on his/her arm or an arm around his/her shoulder for a calming effect when the fidgeting is first noted. The closeness signals the child to use self-control. It is least restrictive and should be tried initially before any other option

The family of a child diagnosed with attention deficit hyperactivity disorder (ADHD), inattentive type, is told the evaluation of their child's care will focus on symptom patterns and severity. What is the focus of child's evaluation? (Select all that apply.)

Academic performance

Activities of daily living

Physical growth

Social relationships

Personal perception

Academic performance

Activities of daily living

Social Relationships

Personal perception

for the family and child with ADHD, evaluation will focus on sx patterns and severity. For those with ADHD inattentive type, the focus of evaluation will be those above ^^. For those with ADHD hyperactive impulsive type or combined, the focus will be on both academic and behavioral responses.

The mother of a 3-year-old boy just diagnosed with autism spectrum is tearful and states, "The doctor said we need to start therapy right away. I just don't understand how helpful it will be—he's only 3 years old!" What response should the nurse provide to the mother's statement?

"You are right, 3 years old is very young to start therapy, but it will make you feel better to be doing something."

"Starting him on treatment now gives Taylor a much greater chance for a productive life."

"If your child starts therapy now, he will be able to stop therapy sooner."

"If you have questions, its best to ask the doctor."

"Starting him on treatment now gives Taylor a much greater chance for a productive life."

Early intervention for children with autism can greatly enhance their potential for a full, productive life. 3 years old is not too young to start therapy since the sooner therapy is started, the better the outcome. The patient will most likely not be able to stop therapy as interventions will continue indefinitely. Telling the mother to ask her provider abdicates the nurse's responsibility to provide education to patients and families.

What are the foundational concerns regarding the use of restraint and seclusion when providing care to children? (Select all that apply.)

Parents may initiate a lawsuit if injury occurs.

Staff have conflicted feelings leading to ineffectiveness.

Research suggests both are psychologically and physically harmful.

Staff tends to be undertrained in use of restraints in children.

The principle of least restrictive intervention is a primary concern.

Research suggests both are psychologically and physically harmful.

The principle of least restrictive intervention is a primary concern.

Restraint and seclusion have been shown to be psychologically harmful and may also be physically harmful and result in injury or death. To ensure that the civil and legal rights of individuals are maintained, techniques are selected according to the principle of least restrictive intervention. This principle requires that you use more-restrictive interventions only after attempting less restrictive interventions to manage the behavior that have been unsuccessful. The other options are not correct reasons why restraint and seclusion are controversial in children.

A 12-year-old male patient diagnosed with Tourette's disorder is visiting his provider. The nurse will prepare medication teaching on which class of medication to help manage the tics associated with this disorder? (Select all that apply.)

Mood stabilizers

Antianxiety agents

Anticholinesterase inhibitors

First-generation antipsychotics

Second-generation antipsychotics

Antianxiety agents

First-generation antipsychotics

Second-generation antipsychotics

Drugs with Food and Drug Administration (FDA) approval for treating tics are the first-generation antipsychotics haloperidol and pimozide, and the second-generation antipsychotic aripiprazole.

Clonidine hydrochloride, an alpha 2-adrenergic agonist, used to treat hypertension, is also prescribed for tics. While less effective and far slower acting than the antipsychotics, it has fewer side effects. The antianxiety drug clonazepam (Klonopin) is used as a supplement to other medications. It may work by reducing anxiety and resultant tics. The other options are not used or approved for the treatment of Tourette's disorder.

A 9-year-old patient has been diagnosed with an intellectual development disorder (IDD). Which assessment findings support this diagnosis? (Select all that apply.)

Unable to explain the phrase, "Raining cats and dogs"

Reads below age level

Is capable of providing effective oral self care

Enjoy interacting with developmentally similar peers

Physically lashes out when frustrated

Unable to explain the phrase, "Raining cats and dogs"

Reads below age level

Physically lashes out when frustrated

IDD is characterized by severe deficits in three major areas of functioning: intellectual, social, and managing daily life. These children demonstrate difficulty with self care and with almost any social interactions.

An 8-year-old patient is newly diagnosed with attention deficit hyperactivity disorder (ADHD). It is important that the parents be educated to the fact that symptoms will take which form? (Select all that apply). of, inattention, and impulsivity have to be apparent:

Low frustration tolerance

Poor school performance

Impulsive behaviors

Easily intimidated

Mood swings

Low frustration tolerance

Poor school performance

Impulsive behaviors

Mood swings

Individuals with ADHD show an inappropriate degree of inattention, impulsiveness, and hyperactivity. Attention problems and hyperactivity contribute to low frustration tolerance, temper outbursts, labile moods, poor school performance, peer rejection, and low self-esteem. ADHD is not generally characterized by meekness or by being easily intimidated.

Which statement demonstrates a well-structured attempt at limit setting?

a. "Hitting me when you are angry is unacceptable."

b. "I expect you to behave yourself during dinner."

c. "Come here, right now!"

d. "Good boys don't bite."

"Hitting me when you are angry is unacceptable."

Which activity is most appropriate for a child with ADHD?

a. Reading an adventure novel

b. Monopoly

c. Checkers

d. Tennis

Tennis

Cognitive-behavioral therapy is going well when a 12-year- old patient in therapy reports to the nurse practitioner:

a. "I was so mad I wanted to hit my mother."

b. "I thought that everyone at school hated me. That's not true. Most people like me and I have a friend named Todd."

c. "I forgot that you told me to breathe when I become angry."

d. "I scream as loud as I can when the train goes by the house."

"I thought that everyone at school hated me. That's not true. Most people like me and I have a friend named Todd."

What assessment question should the nurse ask when attempting to determine a teenager's mental health resilience? Select all that apply.

a. "How did you cope when your father deployed with the Army for a year in Iraq?"

b. "Who did you go to for advice while your father was away for a year in Iraq?"

c. "How do you feel about talking to a mental health counselor?"

d. "Where do you see yourself in 10 years?"

e. "Do you like the school you go to?"

A"How did you cope when your father deployed with the Army for a year in Iraq?"

B"Who did you go to for advice while your father was away for a year in Iraq?"

D"Where do you see yourself in 10 years?"

Which factors tend to increase the difficulty of diagnosing young children who demonstrate behaviors associated with mental illness? Select all that apply.

a. Limited language skills

b. Level of cognitive development

c. Level of emotional development

d. Parental denial that a problem exists

e. Severity of the typical mental illnesses observed in young children

a. Limited language skills

b. Level of cognitive development

c. Level of emotional development

Pam, the nurse educator, is teaching a new nurse about seclusion and restraint. Order the following interventions from least (1) to most (5) restrictive:

a. With the patient identify the behaviors that are unacceptable and consequences associated with harmful behaviors

b. Placing the patient in physical restraints

c. Allowing the patient to take a time-out and sit in his or her room

d. Offering a PRN medication by mouth

e. Placing the patient in a locked seclusion room

1. With the patient identify the behaviors that are unacceptable and consequences associated with harmful behaviors

2. Offering a PRN medication by mouth

3. Allowing the patient to take a time-out and sit in his or her room

4. Placing the patient in a locked seclusion room

5. Placing the patient in physical restraints

In pediatric mental health there is a lack of sufficient numbers of community-based resources and providers, and there are long waiting lists for services. This has resulted in: Select all that apply.

a. Children of color and poor economic conditions being underserved

b. Increased stress in the family unit

c. Markedly increased funding

d. Premature termination of services

a. Children of color and poor economic conditions being underserved

b. Increased stress in the family unit

d. Premature termination of services

Child protective services have removed 10-year-old Christopher from his parents' home due to neglect. Christopher reveals to the nurse that he considers the woman next door his "nice" mom, that he loves school, and gets above average grades. The strongest explanation of this response is:

a. Temperament

b. Genetic factors

c. Resilience

d. Paradoxical effects of neglect

C. Resilience

April, a 10-year-old admitted to inpatient pediatric care, has been getting more and more wound up and is losing self-control in the day room. Time-out does not appear to be an effective tool for April to engage in self-reflection. April's mother admits to putting her in time-out up to 20 times a day. The nurse recognizes that:

a. Time-out is an important part of April's baseline discipline.

b. Time-out is no longer an effective therapeutic measure.

c. April enjoys time-out, and acts out to get some alone time.

d. Time-out will need to be replaced with seclusion and restraint.

b. Time-out is no longer an effective therapeutic measure.

Adolescents often display fluctuations in mood along with undeveloped emotional regulation and poor tolerance for frustration. Emotional and behavioral control usually increases over the course of adolescence due to:

a. Limited executive function

b. Cerebellum maturation

c. Cerebral stasis and hormonal changes

d. A slight reduction in brain volume

b. Cerebellum maturation