Unit 7 1125

UNIT 7

• Instructor: M. Shackelford MSN, RN

NEURODEVELOPMENTAL DISORDERS

• Key Disorders:

  • Autism

  • ADHD

AUTISM

• Overview:

  • Developmental disabilities ranging from mild to severe.

  • Significant deficits in social, communication, and behavioral areas.

  • Hallmark signs appear early in development.

ETIOLOGY

• Genetics:

  • Linked to specific inherited genes.

  • Includes de novo mutations (not inherited).

• Environment:

  • Advanced parental age as a factor.

  • Claims relating to immunizations lack supporting evidence.

AUTISM LEVELS

• Level 1:

  • Requires some support.

  • May appear awkward or anti-social.

  • Difficulty with change; thrives on routine.

  • Fidgeting may be perceived negatively by others.

• Level 2:

  • Requires more support.

  • Disability is evident to most people.

  • Limited social engagement and poor handling of change.

  • Noticeable repetitive behaviors and developmental delays.

• Level 3:

  • Requires the most support.

  • Disability is apparent to everyone.

  • Limited communication; adherence to routines is vital.

  • Significant developmental delays and missed milestones.

COMORBIDITIES

• Common coexisting conditions:

  • ADHD

  • Epilepsy

  • Psychiatric/behavioral complaints

  • Gastrointestinal disorders

  • Depression

INTERVENTIONS

• Screening and referrals

• Structured environment needed.

• Concise, developmentally appropriate communication.

• Role-modeling of social skills.

• Encouragement of verbal communication.

• Limit stimming and ritualistic behaviors.

• Provide advance notice for changes in routine.

• Ensure safety for the individual.

THERAPIES

• Family Therapy

• Play &/or Music Therapy

• Applied Behavior Analysis (ABA)

LIFESPAN

• Potential issues:

  • Behavioral issues may worsen with age.

  • Limitations on social life.

  • Employment challenges, including underemployment.

MEDICATIONS

• SSRIs: - serotonin reuptake inhibitor

  • Fluoxetine

  • Sertraline

  • Fluvoxamine

• Antipsychotics: - block serotonin and some dopamine. also block norepi, histamine, and acetylcholine. GOAL: reduce hyperactivity , improve mood.

  • Olanzapine

  • Aripiprazole

  • Quetiapine

ADHD (Attention Deficit/Hyperactivity Disorder)

• Core characteristics:

  • Inattention

  • Impulsivity

  • Hyperactivity

• Diagnosis must occur before age 12 and be present in multiple settings.

• Prevalence is 2X-3X higher in children with epilepsy.

• Often leads to negative attention, resulting in low self-esteem.

MANIFESTATIONS

• Difficulty concentrating.

• Easily distracted; short attention span.

• Inability to remain still or quiet; excessive fidgeting.

• Impulsive actions without forethought of consequences.

INTERVENTIONS

• Utilize a calm, respectful approach.

• Model acceptable behavior effectively.

• Secure child’s attention before giving directions.

• Provide short, clear explanations.

• Establish clear limits and maintain consistency.

• Plan physical activities for energy release and success recognition.

• Focus on child’s strengths, not just challenges.

MEDICATIONS

• Stimulants:

  • Amphetamine Salts

  • Dextroamphetamine

  • Dexmethylphenidate

  • Lisdexamfetamine dimesylate

• SNRIs:

  • Atomoxetine

  • Bupropion

DISRUPTIVE BEHAVIORAL DISORDERS

• Key Disorders:

  • Oppositional Defiant Disorder (ODD)

  • Conduct Disorder (CD)

  • Intermittent Explosive Disorder (IED)

GOALS OF TREATMENT

• Reduce impulsiveness and aggression.

• Manage anger and improve problem-solving abilities.

COMORBIDITIES IN DISRUPTIVE DISORDERS

• Physical Health Concerns:

  • High blood pressure, diabetes, heart disease, ulcers, chronic pain.

• Mental Health Issues:

  • Depression, anxiety, substance use disorders, increased suicide risk.

OPPOSITIONAL DEFIANT DISORDER (ODD)

• Characteristics:

  • Common and mildest disruptive disorder.

  • Negative impact on home, school, and social groups.

  • Symptoms typically appear during preschool or early elementary years.

ETIOLOGY

• Biological/Genetic:

  • Family history of mood disorders or substance use disorders.

• Environmental/Social:

  • Issues like poverty, abuse/neglect, family instability, and inconsistent discipline.

MANIFESTATIONS OF ODD

• Angry and irritable mood.

• Argumentative behavior directed towards authority figures.

• Defiant and vindictive actions.

• Disruption and annoyance of others as a form of manipulation.

INTERMITTENT EXPLOSIVE DISORDER (IED)

• Description:

  • Lack of control over anger/aggression; sudden aggressive outbursts.

  • Episodes last around 30 minutes or less.

  • Significant distress caused to individual and others.

  • Challenges in social, work, and academic environments due to impulsivity and lack of regulation.

ETIOLOGY OF IED

• Genetic Factors:

  • Family history of IED.

• Environmental/Social Factors:

  • Experience of physical or emotional trauma; long-term separation from family in childhood.

MANIFESTATIONS OF IED

• Increased energy and irritability.

• Tension leading to yelling or being argumentative.

• Physical altercations or temper tantrums.

• Extreme anger or threats.

• Assaulting people, animals, or property.

• Racing thoughts during aggressive acts.

• Feelings of depression or fatigue post-outburst.

CONDUCT DISORDER (CD)

• Definition:

  • Persistent aggression that violates rights of others.

  • Poor performance in social and academic settings is typical.

• Symptoms commonly occur from preschool years and rarely after age 16.

ETIOLOGY OF CD

• Genetic Risk Factors:

  • Family history of CD, ADHD, substance use, or mood disorders.

• Environmental Factors:

  • Incidents of trauma, inconsistent parenting.

MANIFESTATIONS OF CD

• Aggressive behavior towards others and animals.

• Property destruction and deceitfulness.

• Serious rule violations.

THERAPIES FOR DISRUPTIVE DISORDERS

• Types of Therapy:

  • Cognitive Behavioral Therapy (CBT)

  • Family therapy

  • Group therapy

  • Multisystemic Therapy (MST)

STRATEGIES FOR MANAGEMENT

• Start from a position of respect.

• Maintain composure.

• Clearly define expectations.

• Identify triggers leading to disruptive behavior.

• Prepare clients for change proactively.

• Offer choices to empower clients.

TIME OUT TECHNIQUE

• Not intended as punishment.

• Aids in defusing situations and promoting self-regulation.

• Requires consistency for effectiveness.

IMPLEMENTING TIME OUT

• Communicate that time out will occur.

• Designate a predetermined area for time out.

• Respond promptly to issues.

• Keep interventions brief, and remain calm.

• Providing no attention during time out.

MEDICATIONS FOR DISRUPTIVE DISORDERS

• Types:

  • Alpha2-adrenergic Agonists

  • Antipsychotics

  • SSRIs

ADDITIONAL THERAPIES

• Cognitive Behavioral Therapy (CBT)

• Trigger identification

• Anger management strategies

• Cognitive restructuring methods