Childhood, Neurodevelopmental & Eating Disorders – Prof. Cheesman (Week 5)

Vocabulary flashcards cover major terms, disorders, risk factors, medications, complications, and nursing considerations discussed in Week 5 lecture on childhood, neurodevelopmental, impulse-control, and eating disorders.

Factors Impeding Diagnosis (Children)

Limited language/cognitive skills, wide variation of normal behavior, and difficulty interpreting if behavior is pathological delaying care.

Protective Factors (Child Mental Health)

Accurate reality testing, positive self-concept, age-appropriate coping, mastery of tasks, creative self-expression, and healthy relationships.

Genetic/Chromosomal Risk

Hereditary links seen in schizophrenia, bipolar disorder, autism spectrum disorder, ADHD, and intellectual disability.

Social & Environmental Risks (Child)

Severe marital discord, low SES, overcrowded large families, parental criminality or substance use, maternal mental illness, foster care placement.

Biochemical Risk Factors

Altered levels of norepinephrine, serotonin, and dopamine associated with some childhood disorders.

Cultural/Ethnic Risk Factors

Problems with assimilation, lack of role models/support within dominant culture increasing vulnerability.

Resiliency

Capacity to adapt, form nurturing bonds, use effective coping, and apply problem-solving despite stress or trauma.

Oppositional Defiant Disorder (ODD)

Pattern of negativistic, hostile, disobedient, defiant behavior toward authority; often blames others and shows low frustration tolerance.

Common Oppositional Defiant Disorder Manifestations

Stubbornness, argumentativeness, limit-testing, refusal to compromise or accept responsibility; usually directed at familiar adults.

Intermittent Explosive Disorder (IED)

Recurrent impulsive verbal/physical aggression causing harm; onset 6–21 yr, more in males; followed by shame or regret.

Intermittent Explosive Disorder Long-Term Risks

Can impair relationships/work and contribute to chronic HTN or diabetes mellitus.

Conduct Disorder (CD)

Persistent pattern violating others’ rights or societal rules (aggression, property destruction, deceit/theft, serious rule violation).

Childhood-Onset Conduct Disorder

Begins before age 10; more prevalent in boys.

Adolescent-Onset Conduct Disorder

Begins after age 10; male–female ratio roughly equal.

Key Conduct Disorder Manifestations

No remorse, bullying, weapon use, cruelty to people/animals, property destruction, theft, truancy, running away.

Disruptive Mood Dysregulation Disorder (DMDD)

Severe recurrent temper outbursts (≥3/week) in 2+ settings with persistent angry mood; onset 6–18 yr.

Oppositional Defiant Disorder Pharmacologic Approach

Meds not routine; alpha-2 adrenergic agonists (guanfacine, clonidine) sometimes used.

Intermittent Explosive Disorder Medications

SSRI (fluoxetine), mood stabilizer (lithium), antipsychotics (clozapine, haloperidol), and beta-blockers.

Conduct Disorder Medications

Second/third-generation antipsychotics (risperidone, olanzapine, quetiapine, aripiprazole), TCAs, benzodiazepines, mood stabilizers, alpha-2 agonists.

Disruptive Mood Dysregulation Disorder Medication Strategy

Antidepressant therapy tailored to symptoms.

Types of ADHD

Predominantly inattentive, predominantly hyperactive-impulsive, and combined type.

ADHD Diagnostic Criteria

Behaviors present before age 12 and observed in two or more settings (home, school, etc.).

Core ADHD Symptoms – Inattention

Difficulty sustaining attention, listening, or focusing on tasks.

Core ADHD Symptoms – Hyperactivity

Fidgeting, inability to sit still, inappropriate running/climbing, excessive talking.

Core ADHD Symptoms – Impulsivity

Blurting answers, interrupting, difficulty waiting turns, acting without consequence consideration.

Psychostimulants for ADHD

Methylphenidate, amphetamine mixture, dextroamphetamine, dexmethylphenidate, lisdexamfetamine; boost dopamine & norepinephrine.

Atomoxetine

Selective norepinephrine reuptake inhibitor used for ADHD; non-stimulant, non-narcotic.

Bupropion (ADHD)

Atypical antidepressant elevating dopamine & norepinephrine; non-narcotic option.

Alpha-2 Adrenergic Agonists (ADHD)

Guanfacine and clonidine; reduce hyperactivity/impulsivity.

Autism Spectrum Disorder (ASD)

Complex genetic neurodevelopmental condition causing impaired communication/interaction and restricted, repetitive behaviors.

Characteristic Autism Spectrum Disorder Behaviors

Poor eye contact, repetitive actions, strict routine adherence.

Autism Spectrum Disorder Physical Difficulties

Issues with sensory integration, sleep, digestion, feeding, epilepsy, allergies.

Autism Spectrum Disorder Medication Options

SSRIs and atypical antipsychotics (risperidone, olanzapine, quetiapine, aripiprazole), TCAs for associated symptoms.

Intellectual Developmental Disorder (IDD)

Early-onset deficits in intellectual functions (reasoning, learning) plus impaired adaptive behavior requiring ongoing support.

Specific Learning Disorder

Persistent difficulty in reading (dyslexia), writing (dysgraphia), or math (dyscalculia) despite normal intelligence/education.

Psychostimulant – CNS Stimulation

Side effects include insomnia & restlessness; dose timing before 1600 & caffeine reduction help.

Psychostimulant – Weight Loss

Reduced appetite may suppress growth; monitor height/weight, consider drug holidays.

Psychostimulant Toxicity

Dizziness, palpitations, HTN, hallucinations, seizures; treat with chlorpromazine, diazepam, and fluids.

Psychostimulant Cardiovascular Risk

Dysrhythmias, chest pain, sudden death in cardiac patients; monitor vitals & ECG.

Psychostimulant Psychosis/Paranoia

Discontinue drug and notify provider immediately.

Psychostimulant Withdrawal

Headache, N/V, weakness, depression; avoid abrupt cessation.

Transdermal Methylphenidate Reaction

Hives/papules at site; remove patch & contact provider.

Psychostimulant Contraindications

Substance use disorder, serious cardiac disease, severe anxiety, psychosis, pregnancy category C; avoid MAOIs & caffeine.

Psychostimulant Administration Teaching

Take 30-45 min before meals, last dose by 1600, do not crush SR forms, rotate hip patch daily (≤9 h), no alcohol.

Anorexia Nervosa

Self-starvation leading to significantly low weight (<85% expected), fear of weight gain, distorted body image.

Restricting-Type Anorexia

Weight loss through dieting, fasting, excessive exercise without binging/purging.

Binge-Eating/Purging Anorexia

Primarily restricting but intermittently binges and purges; higher impulsivity & substance abuse risk.

Bulimia Nervosa

Recurrent binge eating followed by compensatory behaviors (purging or non-purging) at least weekly for 3 months.

Purging-Type Bulimia

Compensation via vomiting, laxatives, diuretics, or enemas.

Non-Purging Bulimia

Compensation via excessive exercise, fasting, or diet pills.

Binge-Eating Disorder (BED)

Recurrent uncontrollable binges without compensation, causing distress; common ages 46-55 and linked to obesity-related diseases.

Eating Disorder Occupational Risks

Professions emphasizing thinness (modeling, ballet, wrestling) increase risk.

Key Biological Eating Disorder Factors

Hypothalamic, hormonal, or serotonin pathway imbalances; familial genetic predisposition.

Core Cognitive Distortions (ED)

Overgeneralization, all-or-nothing, catastrophizing, personalization, emotional reasoning.

Lanugo

Fine downy hair on face/body seen in anorexia due to malnutrition.

Russell’s Sign

Calloused/abraded knuckles from self-induced vomiting in bulimia.

Anorexia – Vital Sign Changes

Bradycardia, hypotension (incl. orthostatic), hypothermia.

Bulimia – Typical Weight

Often within normal range or slightly overweight despite disordered behaviors.

Criteria for ED Acute Care

Rapid weight loss >30% in 6 mo, HR<40, SBP<70, temp<36 °C, severe electrolyte/ECG changes, suicidal or psychotic features.

Structured Milieu (ED)

Highly organized environment with meal supervision, weight monitoring, and consistent limits to reduce anxiety around food.

CBT Techniques for ED

Cognitive reframing, relaxation, journaling, and desensitization to challenge distorted thoughts.

Dietician Collaboration (ED)

Structured meal schedule, small frequent meals, high-fiber/low-sodium diet start, vitamin supplement, caffeine avoidance.

Refeeding Syndrome

Potentially fatal fluid/electrolyte shifts (↓phosphate, K+, Mg2+) after rapid nutrition of malnourished patient; refeed slowly.

Pica

Persistent eating of nonfood substances (dirt, paper) beyond toddlerhood and not culturally sanctioned.

Rumination Disorder

Repeated regurgitation and rechewing or spitting of food without medical reason.

Low Self-Esteem (ED & Conduct Disorders)

Common psychological feature contributing to maladaptive behaviors and requiring therapeutic focus.

Alpha-2 Adrenergic Agonist – Guanfacine

Non-stimulant med used in ODD, CD, and ADHD for impulsivity/hyperactivity control.

Second-Generation Antipsychotics

Risperidone, olanzapine, quetiapine used in CD and ASD for aggression and irritability.

Fluoxetine (IED)

SSRI shown to reduce impulsive aggression in intermittent explosive disorder.

Lithium (IED)

Mood stabilizer that dampens aggressive outbursts in intermittent explosive disorder.

Refeeding Electrolyte Priority

Monitor and replace phosphate first, along with potassium and magnesium, to prevent cardiac/respiratory failure.

BMI <17 or <15 (Anorexia Severity)

Classification used to gauge illness severity and decide treatment intensity.

Overcrowding (Risk Factor)

Living in cramped housing elevates stress and risk for childhood behavioral disorders.

Limit-Testing Behavior

Deliberate attempts by ODD/CD youth to determine how far rules can be pushed; requires consistent consequences.

Sleep Disorders in ASD

Insomnia or irregular sleep–wake cycles frequently complicate autism management.

Hypersensitivity Skin Reaction (Patch)

Contact dermatitis to methylphenidate patch; treat by removal and provider notification.

Hallucination Management (Stimulant Toxicity)

Administer chlorpromazine to control psychotic symptoms.

Seizure Management (Stimulant Toxicity)

Use diazepam IV/IM for seizure control.

Avoid MAOI + Stimulant Gap

Stop MAOIs at least 14 days before starting psychostimulants to prevent hypertensive crisis.

High Potential for Abuse (Stimulants)

DEA-scheduled; require handwritten monthly prescriptions and secure storage.

Purging Medical Complications

Dental erosion, parotid enlargement, esophageal tears, electrolyte imbalances, cardiomyopathy.

Electrolyte Imbalance – Hypokalemia

Low potassium often from vomiting or laxative/diuretic abuse in bulimia; risk for arrhythmias.

Amenorrhea

Absence of menstruation frequently found in anorexia due to low body fat and hormonal disruption.

Peripheral Edema (ED)

Fluid accumulation in extremities seen in both anorexia and bulimia from hypoalbuminemia or cardiac strain.