NSG 3320: Neurodevelopmental Disorders

Developmental disability (aka neurodevelopmental disorder)

Umbrella term for mental and/or physical disabilities that cause impairments in various aspects of a person's life and originate prior to 18 years of age

Fetal alcohol spectrum disorder

Disorder affecting people whose mothers consumed large amounts of alcohol while they were pregnant; results in impaired neurocognitive functioning, impaired self-regulation, impairment in adaptive functioning

True

True or false? FASD does not always include characteristic facial features

Confabulation

Occurs when brain unconsciously takes pieces on info from day and weaves them together to form a new memory; can sound like lying, fabrication or stories, but to pt with FASD it is a real and true memory

Information processing deficit

Occurs when information is recorded, interpreted, stored, or retrieved; person with FASD may take longer to process information/cannot process it at all; other's may perceive this as the person being a "poor listener"

Sensory overload

Amount of noise, light, smells, or touch makes someone fell so uncomfortable that they are overwhelmed, cannot focus, and "shut down"; becomes difficult for them to calm down and other may perceive them as inattentive

Dysmature

Characteristic of people with FASD; difficulty meeting a developmental milestone and outsiders may view them as immature and not acting their age; chronological age is 12 but age their brain functions at is 7

Cause and effect

People with FASD struggle with this; it means they cannot connect their actions to the possible consequences; may be labeled "impulsive" by outsiders

Abstract vs Concrete

Concepts such as time, money, sarcasm, and metaphors are considered abstract and are sometimes confusing or difficult for people with FASD to understand; best to explain things using plain language and concrete examples

Everyone!!!

Which pregnant persons should the universal alcohol screening be used with?

Strengths based (identify what the patient enjoys, is good at, times they have been successful)

What kind of approach should be used with FASD patients?

Intellectual disability

Developmental disorder with:

1. Deficit in cognitive functioning

2. Deficit in 1+ domain of adaptive functioning (conceptual, social, practical domains)

3. Onset during development (before 18-21 y/o)

Cognitive functioning

Reasoning, judgement, academic and experiential learning; evaluated clinically and by IQ testing (must be below 70 to qualify as ID)

Conceptual domain

Communication/language, reading, writing, math

Social domain

Social judgement, friendship making abilities, empathy

Practical domain

Independence in ADLs and role function

SLP, OT, PT, developmental stimulation

What are some early intervention services for people with IDs?

STOMP campaign

Stopping overmedication of people with developmental disabilities

Autism spectrum disorder

Disorder that appears in childhood and is marked by significant deficiencies in communication and social interaction, and by rigidly fixated interests and repetitive behaviors

Deficits in social reciprocity, nonverbal behavior, and relationship development, maintenance, and function

What are some example of impaired social communication and social interaction seen in ASD?

Repetitive movements, insistence on sameness, restricted interests, hyper/hypo-reactivity to sensory input

What are some restrictive/repetitive patterns of behavior, interest, or activities seen in ASD?

50%

What percentage of people diagnosed with ASD have a concurring intellectual disability?

False (3x more prevalent in boys, underrecognized in girls)

True or false? ASD is more prevalent in girls yet continues to be underrecognized in them

Applied behavioral analysis

Intensive treatment for autism, based on operant conditioning; involves analyzing antecedent (what happened before they engaged in the behavior), specific behavior, and the consequence (how does the child respond, how does the family respond)

Disability discrimination related traumas

Bullying/exclusion, service navigational barriers, exclusion/discrimination from mainstream health and social services, denial of autonomy and person directed care

Assumed

As nurses, we should be shifting our mindset from a trauma informed approach to a trauma ____________ approach.

Reasonable adjustment

Making services accessible and effective in advance to a person using the service when possible

Health passport

A collection of information that allows people to express biopsychosocial needs and preferences in an easy-to-share format; shares a photo, likes/dislikes, supports needed, medical hx, current medication, how the person copes with procedures/stressors

Aspiration, bowel obstruction, dehydration, seizures, sepsis

Fatal five preventable prevalent causes of death in patients with IDD

False

True or false? Paid caregivers are legally permitted to be SDM or to provide consent for treatment

Examples of nonverbal communication

Vocalizations, facial expressions, gesturing, postural movements, sign language, augmentative communication strategies, technical tools

True

True or false? You should avoid saying "no" and "don't" with patients with IDDs

Visual schedule

A sequence of events depicted by visual media. These events occur during portion of a day, a day, a week, month, etc.

HELP framework

Health: head to toe assessment, pain

Environment: assess adaptive skills, necessary supports

Live experience and emotional wellbeing: identify traumas and vulnerabilities

Psychiatric disorder: systemic eval

Attention-deficit/hyperactivity disorder (ADHD)

Persistent pattern of inattention, hyperactivity, and impulsivity that is inappropriate for developmental level; inattentive, hyperactive/impulsive, combined

Consistency of problematic behavior

What is a key feature of ADHD?

Methylphenidate, amphetamine

Pharmacological options for ADHD

Oppositional defiant disorder

Persistent pattern of disobedience, argumentative/angry outbursts, low frustration tolerance, and blaming others; treated with behavioral management

Difficulty making friends, low confidence, difficulty with authoritative figures, academic problems, angry/irritable mood, actively defies/refuses to comply with requests

Signs and symptoms of oppositional defiant disorder

Conduct disorder

Repetitive and persistent pattern of behavior in which the basic rights of other or major society rules are violated

Diagnostic criteria: aggression to people/animals, destruction of property, deceitfulness/theft, serious violations of rules

Limit setting, time out, daily schedule

Accept the child not the behavior, diary for reflection of emotions, practice problem solving skills

Teach appropriate social skills, provide positive feedback for acceptable behavior

Nursing interventions for conduct disorder