Notes on Children with Special Needs and Cognitive Impairment

Cognitive Impairment

Definition: A cognitive impairment is a general term encompassing any type of mental difficulty or intellectual deficiency. This condition may affect various cognitive functions, including memory, problem-solving abilities, and reasoning skills, leading to challenges in daily functioning.

Diagnosis: Cognitive impairment is suspected or diagnosed by healthcare professionals or family members for individuals aged 18 years and younger. Screening assessments and standardized tests, including IQ tests, play a pivotal role in evaluating cognitive abilities and deficits in this population.

IQ Criteria: An IQ score of 70 or below is considered subaverage, which may indicate the need for further evaluation and intervention. An IQ score is one of several factors considered when diagnosing cognitive impairment, alongside adaptive functioning and personal history.

Potential Causes:

• Infection: Certain infections during pregnancy or early childhood, such as bacterial meningitis or viral encephalitis, can lead to cognitive impairment.

• Trauma: Head injuries sustained during accidents can result in lasting cognitive deficits.

• Gestational disorders: Complications during pregnancy, such as fetal alcohol syndrome or premature birth, often result in developmental delays.

• Environmental factors: Exposure to toxins (like lead) or socioeconomic disadvantages may contribute to cognitive difficulties, emphasizing the role of the environment in cognitive development.

Areas Impacted:

• Communication skills: Impaired verbal and non-verbal communication abilities, which may complicate social interactions and learning.

• Self-care abilities: Difficulties with daily living skills, including personal hygiene and routine tasks, affecting independence.

• Social skills: Challenges in understanding social cues and forming relationships with peers.

• Academic performance: Underachievement in school, potentially necessitating specialized educational strategies.

• Work skills: Issues in vocational training and job performance due to cognitive challenges.

• Health and safety awareness: Reduced ability to make safe and healthy choices, which can jeopardize overall well-being.

Nursing Interventions for Cognitive Impairment

Early Intervention: Emphasis on education and developmental support from an early age can promote better long-term outcomes. Programs tailored to individual needs can significantly enhance cognitive and adaptive functioning.

Self-Care Skills: Nurses and caregivers should prioritize teaching children essential self-care skills, empowering them to manage personal hygiene, dressing, and feeding.

Encouragement of Play: Play activities are crucial for cognitive development; they should be used as a tool to foster engagement and social interaction among children.

Communication Techniques: Various tools and methods, including picture exchange systems, simplified language, and consistent routines, help improve communication effectiveness for children with cognitive impairments.

Establishing Discipline: A structured environment with consistent routines and rules helps children feel secure and increases their ability to respond to expectations positively.

Nutrition Education: Providing guidance on healthy dietary choices is essential, including information about nutrient-rich foods that support cognitive function and overall health.

Chemical Awareness: Educating parents about the dangers of prenatal exposure to harmful substances such as alcohol and illicit drugs is vital for prevention and management.

Prenatal Care: Highlighting the importance of folic acid during pregnancy and recommending genetic counseling can significantly reduce the risk of cognitive impairments in offspring.

Causes of Cognitive Impairment

Down Syndrome:

• Trisomy 21 is the most common chromosomal abnormality, characterized by the presence of an extra chromosome in 95% of cases. This results in specific developmental and physical features and leads to varying degrees of cognitive impairment.

• Associated with risks related to maternal age, emphasizing the need for prenatal screening and genetic counseling.

• Clinical symptoms often include

  • hypotonia (decreased muscle tone),

  • a flat nasal bridge,

  • an upward slant to the eyes,

  • Respiratory tract infections are prevalent when combined with cardiac anomalies.

• Health Risks: Individuals may experience significant health risks, including congenital heart disease (CHD), hypothyroidism, and an increased risk of leukemia, necessitating comprehensive medical care.

• therapy

  • Assist in prenatal diagnosis and genetic counseling

  • surgery

  • hearing and vision

  • test thyroid functions

    • test is recommended, especially if growth is severely delayed

  • decrease musle tone compromises respiratory expansion. underdeveloped nasal bone causes a chronic problems of inadequate drianage of mucus

    • measures to lessen these problems include clearing the nose with a bulb-type syringe, rinsing the mouth with water after feedings, increasing fluid intake, and using a cool-mist vaporizer to keep the mucous membranes moist and the secretions liquefied

      • change the child’s position frequently, practicing good hand washing, and properly disposing of soiled articles, such as tissues.

Hearing Impairment

• Hearing impairment is a general term indicating disability that may range in severity from slight to profound hearing loss.

• causes

  • Anatomic malformations of the ear can affect auditory function.

  • A family history of hearing issues often predisposes individuals to similar auditory challenges.

  • Low birth weight frequently correlates with an increased risk of hearing impairment.

  • Ototoxic drugs antibiotics

  • Chronic ear infections can lead to conductive hearing loss, especially in children.

  • Perinatal infections, such as rubella, can adversely impact hearing.

Types of Hearing Loss:

• Conductive: Issues affecting the middle ear that may often be surgically correctable or managed with hearing aids to enhance sound transmission.

• Sensorineural: Involves damage to the inner ear or auditory nerve, usually requiring interventions like cochlear implants to restore some level of hearing.

  • The most common causes are congenital defects of inner ear structures or consequences of acquired conditions, such as kernicterus, infection, administration of ototoxic drugs, or exposure to excessive noise.

• Mixed: A combination of both conductive and sensorineural hearing loss, requiring comprehensive treatment approaches.

  • recurrent otitis media and its complications

Assessment: Hearing loss is measured in decibels, with different thresholds indicating varying degrees of impairment.

Signs of Hearing Impairment in Different Ages

Infancy:

• Lack of a startle reflex to loud sounds can indicate hearing impairment.

• No reaction to sounds or failure to respond to a caregiver's voice may necessitate further evaluation.

• Absence of well-formed syllables by 11 months is a critical developmental milestone that should be monitored.

• general indifference to sound

• lack of response to spoken word

Childhood:

• profound deafness

• school testing

• speech abnormalities

• learning disabilities

• prevents recurrent ear infections

• avoidance of noise pollutions

• ototoxic drugs

• Use of gestures rather than verbalization to express desires, especially after 15 months old.

Interventions:

• Lip reading, cued speech, and sign language are essential methods of communication for those with significant hearing impairment.

• Speech therapy supports language development, while communication devices and picture boards facilitate better interaction.

• visual & tactile media

• communication devices

• picture board

Visual Impairment

Causes:

• Can originate from prenatal or postnatal infections

  • herpes, chlamydia, gonococci, rubella, syphilis, toxoplasmosis, meningitis

• retinopathy of prematurity

• Trauma, such as head injuries or infections, can lead to significant visual impairments.

• SCD, JRA, Tay Sachs disease

Common Issues:

• Myopia (nearsightedness) and hyperopia (farsightedness) are common refractive errors.

• Strabismus (crossed eyes) and amblyopia (lazy eye) can severely affect visual coordination and clarity.

Trauma/infections

• common cause of blindness

• injury to eyeballs and adnexa

• penetrating injuries

  • take to emergency department

  • never remove an object that has penetrated eye

  • observe for aqueous or vitreous leaks (fluid leaking from point of penetration)

  • apply a Fox shield if available

  • maintain bed rest with child in a 30 degree fowler position

• conductivities (bacterial/viral) allergy: treatment is usually with ophthalmic antibiotics

  • emergency treatment

    • foreign object: examine eye for presence of a foreign body, remove a freely moveable object with pointed corner of gauze pad lightly moistened with water

    • Chemical burns: Irrigate eye copiously with tap water for 15-20 min, keep room darkened

    • hematoma eye: use flashlight to check for gross hyphema (hemorrhage), apply ice for 1st 24 hrs to reduce swelling

Retinoblastoma:

• The most common congenital malignant intraocular tumor in children, often diagnosed before age 2. It is associated with genetic mutations, emphasizing early detection and treatment.

  • typically parents or relatives are ones who 1st observe a whitish “glow” in the pupil, known as the cat’s eye reflex or leukocoria.

  • a white reflex may be visible when the tumor is small. it is best observed when a bright light is shinning toward the child as the child looks forward, which is why it may be discovered when a flash photograph is taken

• DX: Reese-Ellsworth system

• treatment: radiation and chemotherapy to shrink the tumor

• safety is a major concern to prevent damage to the unaffected eye. safety measures should be practiced at all times, and children should avoid rough contact sports or wear protective eyewear.

Autism Spectrum Disorder (ASD)

Characteristics:

• ASD is a complex neurodevelopmental disorder that significantly impacts communication, social skills, and behavior. Symptoms can manifest in various ways, from mild to severe.

• Signs may include language delays, lack of eye contact, repetitive actions, and a pronounced preference for solitary play, which can affect peer relationships.

  • any child who doens’t display language skills such as babbling or gesturing by 12 months old, single words by 16 months old, and 2 word phrases by 24 months old is recommended for immediate hearing and language evulation

• kids with ASD demonstrate core deficits primarily in social interactions

• constipation

• some children with autism (savants) excel in particular areas, such as art, music, memory, mathematics, or perceptual skills, such as puzzle building

Diagnosis:

• Typically established by age 2-3 years old, relying on observational assessments and parent reports.

  • frequently diagnosed in toddlers because their atypical development is being recognized early

Interventions:

• Early intervention therapies, including structured play, speech therapy, and occupational/physical therapy, can enhance developmental outcomes.

  • objective in treatment is to promote positive reinforcement, increase social awareness of others, teach verbal communication skills, and decrease unacceptable behavior

• Importance of routines, balanced nutrition, socialization opportunities, and discussions about the potential role of medications for co-occurring conditions like anxiety or ADHD.

  • decrease stimulation by using private room, avoiding extraneous auditory and visual distractions, encouraging the parents to bring in possessions the child is attached to lessen the disruptiveness of hospitalization

  • minimal holding and eye contact may be necessary to avoid behavioral outburst

  • gluten-free diet and casein-free diet)

  • vitamin and omega-3 supplementation: a high-fat, low carb ketogenic diet