Disorders in Childhood & Adolescence; Domestic Violence Notes

Intellectual Disability - having low average intelligence and having trouble with everyday skills like communication.

  • Key Features: Key Features of Intellectual Disability:

    1. Low IQ – Typically below 70.

    2. Problems with daily life skills – Trouble with communication, self-care, social skills, or problem-solving.

    3. Early onset – Starts before age 18.

    Common Causes of Intellectual Disability:

    1. Genetic conditions – e.g., Down syndrome, Fragile X syndrome.

    2. Birth problems – Lack of oxygen during birth.

    3. Pregnancy issues – Alcohol use (FAS), infections, poor nutrition.

    4. Childhood illnesses or injuries – Infections (like meningitis), brain injury, malnutrition.

    5. Environmental factors – Extreme neglect or lack of stimulation in early years.

Autism Spectrum Disorder (ASD)

  • Symptoms:

    • Lack of response to name by 1 year.

    • No interest in pointing by 14 months.

    • Absence of pretend play by 18 months.

    • Avoids eye contact and prefers solitude.

    • Speech and language delays.

    • Obsessive interests and distress from routine changes.

    • Repetitive actions (e.g., hand flapping).

    • Unusual reactions to sensory stimuli.

Tic Disorders

  • Tic: Rapid, recurrent movement or vocalization.

  • Simple Motor Tics: Examples include blinking and shoulder jerking.

  • Simple Vocal Tics: Examples include throat clearing and grunting.

  • Complex Vocal Tics: Repeating words out of context.

Tourette Disorder

  • Multiple motor tics along with one or more vocal tics, occurring frequently throughout the day for over a year.

  • Tic severity changes over time.

Chronic Motor or Tic Disorder

  • Presence of either motor or vocal tics, but not both.

Transient Tic Disorder

  • Single or multiple tics lasting no more than 12 months.

Learning Disorders

  • Achievement in reading, mathematics, or writing below expected level for age and intelligence.

Motor Skills Disorder

  • Developmental Coordination Disorder: Impaired coordination.

  • Stereotypic Movement Disorder: Rhythmic, repetitive, purposeless behaviors.

Communication Disorders

  • Deficits in language, speech, and communication.

    • Includes language disorder, speech sound disorder, and stuttering.

Elimination Disorders

  • Encopresis: Repeated defecation in inappropriate places in children over 4 years old.

  • Enuresis: Repeated urination in bed or clothing in children over 5 years old.

  • Treatment involves positive reinforcement for continence.

  • Most children achieve continence by adolescence.

Attention-Deficit/Hyperactivity Disorder (ADHD)

  • Key Features: Inattentiveness, overactivity, and impulsiveness.

  • Consistency of behavior is a key diagnostic feature.

  • May lead to discipline problems, low self-esteem, and peer rejection in adolescence and adulthood.

  • Symptoms may include nervousness, restlessness, and low frustration tolerance.

  • Etiology: Unknown, possibly linked to decreased glucose use in frontal lobes and genetics.

  • Psychopharmacology:

    • Methylphenidate (Ritalin) and amphetamine compound (Adderall).

    • Dextroamphetamine (Dexedrine) and pemoline (Cylert).

    • Atomoxetine (Strattera): Nonstimulant.

Therapeutic Play

  • Techniques include energy release activities and dramatic/creative play for emotional expression.

Abuse and Violence

  • Nurses should ensure client safety, respect personal space, and obtain consent before touching.

Characteristics of Violent Families

  • Includes spouse battering, child abuse, elder abuse, and marital rape.

  • Features: Social isolation, abuse of power, substance abuse, and intergenerational transmission of violence.

Intimate Partner Violence

  • Types: Psychological, physical, and sexual abuse.

Cycle of Abuse

  • Phases: Tension building, violent behavior, remorse/contrition.

Safety Questions

  • Assess safety in relationships and concerns for personal safety.

Child Abuse

  • Sexual Abuse: Sexual acts on a child under 18.

  • Neglect: Withholding necessities.

  • Psychological Abuse: Verbal assaults, family discord, emotional deprivation.

Clinical Picture of Abusers

  • Lack of parenting skills, emotional immaturity, and unmet needs.

Nurse's Role in Reporting Abuse

  • Accurate documentation is essential.

  • Reporting person may remain anonymous.

  • Questions should minimize trauma to the child.

Elder Abuse

  • Types: Physical, sexual, psychological, neglect, financial exploitation.

  • Occurs by family members or caregivers.

  • Self-Neglect: Failure of elder to care for themselves.

Clinical Indicators of Elder Abuse

  • Unexplained injuries, lack of necessities, abuser using victim's finances, and withholding medical care.

Warning Signs (Caregiver Related)

  • Caregiver not allowing elder to speak, indifference/anger, blaming, defensiveness, conflicting accounts, history of substance abuse

Rape and Sexual Assault

  • Rape: Sexual intercourse without consent.

  • Sodomy: Forced oral or anal sex.

  • Myths: Refuted beliefs about rape.

Assessment & Treatment

  • Preserve evidence.

  • Offer prophylactic STD treatment and immediate support.

  • Provide education on rape and violence.

Case Studies

  • ASD: Communication difficulties, regulatory behavior issues.

  • Tourette Syndrome: Tics causing embarrassment, school decline.

  • Abuse/Violence: Suspicious bruises, withdrawn behavior in a child.

  • Elder Abuse: Unexplained injuries, reluctance to seek care, fear.