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Peds Exam 2
Neurodevelopemental Disorders and Cognitive Impairment
| Question | Answer |
|---|---|
| cognitive impairment is intellectual impairment in: | Intellectual functioning Adaptive functioning Onset during childhood, < 18 years old |
| intellectual functioning is measured by | IQ <70 average IQ is 90-109 |
| adaptive functioning is | social and practical skills to care of themself |
| if any of the 3 intellectual impairments are unknown, then | there is a developmental disability |
| developmental disability | Any significant delay in child’s physical, cognitive, behavioral, emotional or social development |
| if child has an intellectual impairment, then they should have | IEP |
| etiology of cognitive impairment | Genetic, biochemical and infectious |
| Individuals with Disabilities Education Act (IDEA) | Protects from discrimination and right to assistance in school/workplace Individual education plan (IEP) |
| ADHD is a | neurodevelopmental disorder |
| ADHD is a behavioral disorder that involves | Developmentally inappropriate degrees of inattention, impulsiveness, hyperactivity |
| Developmentally inappropriate degrees refers to | the fact that behavior might be more normal for younger child but now the child is doing it more than they should or are developmentally older than their behavior shows |
| etiology of ADHD | unknown |
| ADHD is known to be caused by | Dysregulated (low levels) neurotransmission of dopamine Strong family history Exposure to substances Low birth weight and birth complications |
| exposure to what substance can cause ADHD | lead in infancy mom did drugs or drank during pregnancy |
| who is ADHD seen more in | boys more frequently than girls |
| CMs of ADHD: inattentive (cognitive) | distracted!! hallmark sign disorganization impaired executive function |
| CMs of ADHD: hyperactive/impulsive (behavioral) | fidget/restlessness interrupt difficulty in delaying repsonses impatient |
| diganosis of ADHD | age <12 -Sx start around school age (6-7) but definitely before 12 6 or more symptoms that persist for ≥ 6 months: inattention, hyperactivity, impulsivity occur in 2+ settings (school and home) impacts life - adversely affects school/socialbility |
| management of ADHD is a | multimodal approach because it depends on child's age and the severity of their symptoms |
| multimodal approach of ADHD treatment | behavior management (first line approach in children!!) pharmacotherapy (meds) educational interventions (IEP) family education (support) |
| Behavioral intervention for ADHD: goal | prevent undesirable behaviors through positive reinforcement |
| how to prevent undesirable behaviors | Rewarding desirable behaviors Consequences for failure to achieve goals Strategies to improve success (charts!!) |
| Consequences for failure to achieve goals in ADHD | it is important to maintain as much positivity as possible but need to maintain clear and consistent expectations |
| Pharmacotherapy intervention for ADHD | psychostimulants (short vs long acting) most effective/most used invervention |
| how do psychostimulants work | increase dopamine levels in brain by producing a calming effect |
| concern for psychostimulants is | that they will abuse them |
| what are psychostimulants dosed by | effect NOT body weight start on one dose and increase until becomes effective |
| what type of psychostimulants is better for children | long acting, but they must be swallowed |
| what are psychostimulants contraindicated with | tourettes |
| SE of psychostimulants | tics loss of appetite - take with or after meals weight loss insomnia - take med in the morning irritability increased blood pressure |
| Education interventions for ADHD | Decrease distraction Increasing structure (IEP, daily plan) Tools for enhanced performance (not doing work in front of TV, given specific instructions) Consistency between school & home |
| parenting skill intervention for ADHD | Positive parenting (praise, attention, affection) Consistent limit setting Skills for helping kids focus |
| Autism Spectrum Disorder (ASD) is a | neurodevelopmental disorder a collection of disorders with genetic variatoins |
| characteristics areas of ASD | social skills language activities and interests |
| social skills of ASD | Difficulty with social communication and interacting with others |
| language of ASD | Usually restricted, repetitive behaviors, interests, or activities |
| activities and interests | Sensory sensitivities sensitive to sounds and textures |
| risks for ASD | mom taking meds during pregnancy, older age, low birth weight |
| what is one safe med moms can take during pregnancy | acetaminophen |
| when do symptoms of ASD appear | first 2–3 years of life |
| etiology of ASD | largely unknown Complex interaction between genes, brain development, chemicals and environment large genetic component |
| who is ASD recognized more in and why | males because a lot of the signs of ASD fit in with female norms |
| ASD hallmark manifestation | Difficulties with social communication and interaction |
| what may be the first symptoms of ASD | Speech delay |
| CMs of ASD: social communication and interaction | Little/inconsistent eye contact Do not/slow to respond to name Trouble conversing Facial expressions don’t match Flat tone Difficulty understanding others point of view and expressing emotions Do not respond to social cues Do not want to be touched |
| CMs of ASD: Restrictive/Repetitive behavior aka | stimming |
| CMs of ASD: Restrictive/Repetitive behavior | Repetitive movements or speech Insistence on sameness/routines Fixated interests Atypical reactions to sensory input |
| Repetitive movements or speech | Hand-flapping, echolalia- compulsive repetition |
| Atypical reactions to sensory input | Hypersensitivity to sounds or textures |
| comorbidities of ASD | aggression self injury digestive disorders bipolar sleeping disorders anxiety asthma explosive outbursts |
| what are children with ASD good at | puzzles increase visual and auditory skills remembering |
| ASD Diagnosis Treatment Approaches | Behavioral observation Developmental history Positive screening questionnaires at well child visits Comprehensive evaluation |
| Positive screening questionnaires at well child visits | no interest, not responding to name, no imagining, not pointing or making gestures |
| is there a cure for ASD | No cure but there is a supportive, individualized approach |
| Behavior and Communication approaches for ASD | Structured routine- key If non-verbal, communication devices (speech- language therapy, enhance communication with any method that works for them!!) OT- sensory integration |
| medications for ASD | Antipsychotics (risperidone, aripiprazole) - irritability, aggression, self-injury SSRIs (fluoxetine) - anxiety- repetitive behaviors Stimulants (methylphenidate) - attention issues, hyperactivity |
| IEP for ASD | Tailored to child’s strengths and needs |
| Complementary and Alternative medicine for ASD | music therapy and horse back riding |
| ASD Nursing Management: Individual assessment and management | we want to decrease stimuli and maintain consistency |
| Individual assessment and management: ASD | Provide structure, routine - Introduce change slowly Decrease stimuli Enhance communication May need to minimize both physical and eye contact Maintain a safe environment Provide support to child and family |
| Decrease stimuli example | not putting childs room by nurses station that is often noisy |
Created by:
leh195