Chapter 11 - Childhood and Neurodevelopmental Disorders EAQs

A nurse counsels the parents of a child with autistic disorder. The parents say, "We are going to completely redecorate our child's room. We think that will help." Select the nurse's best response.

"Children with autistic disorder usually prefer that things stay the same." Children with autistic disorder are usually inflexible and preoccupied with orderliness and sameness. Redecorating the child's room is likely to upset the child.

The nurse is identifying students in a school who are susceptible to substance use and abuse later in life. The nurse is planning to give behavioral therapy to such students. Which student does the nurse include in the program? Select all that apply.

A student who is extremely shy A student who has aggressive behavior A student whose behavior is rebellious Behavioral traits in children are powerful predictors of substance use and abuse in the future. Shyness, aggressive behavior, or a rebellious nature make a child susceptible to develop a habit of substance abuse in the future. Children who engage in maladaptive behavior tend to repress feelings and do not socialize with others much. It is found that talkative children do not usually get involved in substance abuse in the future. Interest in play activities is a normal behavior seen in a child. The nurse cannot predict that this child is susceptible to future substance abuse.

The nurse is studying the computed tomography (CT) brain scans across various age groups. The nurse finds that the frontal and prefrontal cortex regions are more developed in adolescents as compared to children. What can the nurse infer from this finding? Select all that apply.

Adolescents have better executive functions than children. Adolescents have stronger inhibiting responses than children. Adolescents have better organization and planning skills than children. Adolescents have more developed frontal and prefrontal cortex regions when compared to children. Due to this, adolescents have better executive, planning and organization skills. They have stronger tendencies to inhibit a response compared to children. Adolescents have a greater number of myelinated nerve fibers than younger children. This accounts for the increased speed of information processing and conduction speed of nerve impulses in adolescents compared to children.

A patient with attention deficit hyperactivity disorder also has depression and anxiety. Prescription of which drug should be avoided in the patient to treat attention deficit hyperactivity disorder?

Atomoxetine (Straterra) Use of atomoxetine (Strattera) is associated with increased incidence of suicidal ideation in patients with depression and anxiety. Therefore, a patient with attention deficit hyperactivity disorder who also has depression should not be prescribed atomoxetine (Strattera). Risperidone (Risperdal), methylphenidate (Ritalin), amphetamine salts (Adderall) are not known to cause such side effects and thus can be prescribed to a patient with ADHD having depression.

Which intervention by the nurse helps to introduce ideas and work through issues with children?

Group therapy Group therapy is an intervention that introduces ideas to children and helps them work through their issues. Group therapy includes learning social skills and interacting with peers. Play therapy, family therapy, and behavioral therapy do not help introduce ideas or work through issues. Play therapy is a mode of communication for the assessment of the developmental and emotional status of those children with whom verbal interaction is not possible. Family therapy includes counseling the parents and siblings of a child and motivating all family members to participate in the child's caregiving process. Behavioral therapy includes motivating changes from maladaptive behaviors to desired behaviors.

A nurse is caring for a patient with specific learning disorders. Which behavioral aspects can the nurse find in the patient? Select all that apply.

Inability of the patient to solve a math problem Inability of the patient to read Learning disorders are characterized by difficulty in learning, reading and solving mathematics. An inability to solve a mathematical problem or inability to read indicates learning disorder. In motor disorder, the patient doesn't have the ability to perform new skills due to reduced coordination. A patient is diagnosed with communication disorder when the patient has trouble with making sounds and is unable to communicate. Continuous hand-waving by the patient is seen in motor disorder due to poor coordination.

A 9-year-old patient has deficits in social and intellectual functioning, and cannot manage practical aspects of daily life and functioning. These symptoms/signs support which diagnosis?

Intellectual development disorder (IDD) IDD is characterized by severe deficits in three major areas of functioning: intellectual, social, and managing daily life. Specific learning disorder is diagnosed when a child demonstrates persistent difficulty in the acquisition of reading (dyslexia), mathematics (dyscalculia), or written expression (dysgraphia), and his or her performance is well below the expected performance of peers. Autism is characterized by severe problems in communication skills and social interaction. ADHD is characterized by inattention, impulsivity, and hyperactivity.

The nurse is caring for a toddler with a mental disorder. The nurse identifies that the toddler finds it difficult to communicate with the staff. What action does the nurse take next during the assessment?

Make use of play therapy Play therapy is an effective medium for children with difficulties in verbal communication. Children are provided with toys, art supplies, molding clay, blocks, and puppets. Toddlers with mental disorders communicate with help of these toys as models. Bibliotherapy, journaling therapy, and therapeutic drawing are not used for assessing toddlers with mental disorders because these children may not have adequate cognitive development to perform these tasks. Bibliotherapy is used for older patients who are able to read and understand the materials provided. Journaling therapy is effective in designing treatment protocols for adolescents. Therapeutic drawing is used for younger patients who are able to express their views in the form of pictographic representation.

An 8-year-old diagnosed with attention deficient hyperactive disorder (ADHD) is prescribed an extended release medication to help manage symptoms. The child attends after-school activities four days a week, causing the parents to be concerned about appropriate administration of the medication, especially because the child has stated, "I don't like swallowing pills." According to the following table regarding medications, which medication will best address their concerns?

Methylphenidate (Daytrana) Methylphenidate (Daytrana) is an extended or sustained release form for children ages 6--12 that can be administered by transdermal patch once daily. Amphetamine/dextroamphetamine, methylphenidate (Concerta), and dexmethylphenidate are all administered in the oral form.

A nurse observed that during play therapy, a patient is unable to follow the rules of the game and has conflict with peers. Which of these drugs would you anticipate would be administered to the patient?

Methylphenidate (Ritalin) A patient with attention deficit hyperactivity disorder does not follow rules in a game and has conflicts with peers. Methylphenidate (Ritalin) is a physicostimulant drug used in attention deficit hyperactivity disorder. Botulinum toxin type A (Botox) is given in Tourette's syndrome to calm the muscles. Naltrexone (Revia) is an opioid antagonist which is usually given in Tourette's syndrome to block the euphoric responses. Diphenhydramine (Benadryl) is an antihistaminic drug prescribed for allergies.

Which part of the nursing assessment includes assessing sensory functions?

Neurological assessment Assessment for neurobiological disorders includes several segments as part of the treatment plan. Assessing sensory function helps to determine the neurological status of a patient. Assessing sensory function is not a parameter for understanding mental status, health of the family, or developmental status of the patient. Assessment of mental health includes assessing general appearance, activity levels, and the intellectual function of the patient. Family assessment includes the relationships between the patient and their family members. Developmental assessment includes assessment of psychomotor skills, language skills, and cognitive skills.

A patient is admitted to the hospital with a diagnosis of autism spectrum disorder (ASDs). Which medications should the nurse anticipate to be included in the patient's treatment plan?

Olanzapine (Zyprexa) Olanzapine is an atypical antipsychotic drug used to reduce harmful behavior in patients with ASDs. Clonazepam is a benzodiazepine class of drug used in reducing anxiety in patients with attention deficit hyperactivity disorder (ADHD). Clonidine hydrochloride is an alpha 2- adrenergic used for treating hypertension in ADHD. Atomoxetine is a nonstimulant selective norepinephrine reuptake inhibitor prescribed to ADHD patients to improve attentiveness.

The nurse is assessing a 10-year-old child who is performing poorly in school. On assessment, the nurse finds that the child has a learning disability. Which observation has led the nurse to come to this conclusion? Select all that apply.

The child was unable to read a story book. The child was unable to perform basic calculations. The child was unable to write properly on paper Inability to read is referred to as dyslexia, inability to perform simple calculations is called dyscalculia, and the inability to write properly is called dysgraphia. These are the criteria for diagnosing a learning disorder. If the child does not answer the nurse's question, the nurse cannot conclude that the child has a learning disorder. There can be many causes that can prevent the child from talking to the nurse, such as depression or fear. Similarly, there can be many reasons why the child is not able to pay attention in class, such as depression or preoccupation with thoughts. A nurse cannot infer that the child has a learning disorder with this information.

A child in a pediatric mental health facility has depression and occasionally gets violent. The nurse decides to design a seclusion room where the child would be transferred next time he or she becomes violent. The nurse keeps few soft toys in the room. What is the reason for the nurse to keep these soft toys?

The child will express anger by punching the toys The nurse is designing a seclusion room where children can be kept when they get violent. Ideally, the room should be nonstimulating. A child should be able to regain self-control in this room. The purpose for keeping soft toys is that children can throw or punch the soft toy to release anger. This would help the child to express anger in a nondestructive manner. The soft toys are not necessarily helpful in inducing sleep in the child. The child is aggressive and violent and it is unlikely that the child plays with the toys in such a state. Seeing the toys would not calm down the child directly.

A nurse is caring for a child with separation anxiety. The child does not interact with anybody and stays in one corner of the room. The nurse decides to give bibliotherapy to this child. What is the primary aim of the nurse to give this intervention?

The child would be able to gain insight into feelings The child has separation anxiety. Bibliotherapy is a therapy where literature is used to help the child to develop insight into his or her feelings and emotions. The child is made to read or listen to a story. While doing this, the child unconsciously relates to the characters of the story and this helps the child to develop an insight into his or her own feelings and behavior. Identifying with the story would help the child to express feelings. This would indirectly relax the child but does not have a direct relaxing effect. The child does not interact with anybody and stays in one corner of the room. This does not indicate that the child has destructive behavior. Listening to or reading stories will not be helpful for the child to develop good communication skills unless done on a long-term basis.

The parent of a child diagnosed with Tourette's syndrome says to the nurse, "I think my child is faking the tics because they occur in different places at different times." Select the correct response by the nurse.

The movements are real. Tics can occur anywhere in the body and can change in frequency and severity.

A school nurse observes a child in one of the classes who frequently slaps his own face, bangs his head against the wall, and uses repetitive language patterns. What appropriate suggestion should the nurse give to the parents and caregivers of the patient?

The nurse should suggest hospitalizing the child briefly A child who frequently slaps his own face, bangs his head, and uses repetitive language is likely suffering from intellectual development disorder. The nurse should suggest that the child should be hospitalized for a short term for evaluation. The education provided should be supportive to the child and match his or her cognitive level and nature of illness but that does not always mean the child must be removed from school permanently. A nurse cannot suggest medications as they can only be prescribed by a primary health care provider. The child should be encouraged to mingle with the peer group and play. Playing helps children express thoughts and emotions.

To confirm the diagnosis of attention deficit hyperactivity disorder (ADHD), a child's symptoms of hyperactivity, inattention, and impulsivity must meet which criteria?

They occur both at home and at school. For ADHD to be diagnosed, the symptoms have to be present in two settings, such as home and school, with onset occurring before the age of 7 years. Worsening symptoms in times of severe stress and confirmation by supervised clinical observations and a diagnostic testing tool do not describe two settings.

A nurse counsels parents of a child diagnosed with moderate autism spectrum disorder (ASD). The parents say, "We are going to move our child to a different bedroom in our home. We think the change will be intellectually stimulating." Select the nurse's therapeutic response.

"Children with autism spectrum disorder usually prefer for things to stay the same." The child with ASD usually has stereotypical behavior, interests, and activities along with overadherence to routines or rituals and fixations with particular objects. Changing the child's room will be disruptive. The nurse should offer other ideas for intellectually engaging the child, but avoid over-stimulation that may result in agitation. Sharing a bedroom could be disruptive to other children in the family. Parents have an on-going responsibility to supervise the child, regardless of where the child's bedroom is located.

Which question directed to the parents would focus upon the broad categories addressed during a mental health assessment of their school-aged child? Select all that apply.

"Has your child ever intentionally hurt himself or others?" "What does the teacher say about your child's behavior in school?" "How would you describe your child's level of physical activity?" "What are your child's favorite toys and activities?" Assessment of mental status of children includes the following broad categories: safety, general appearance, socialization, activity level, speech, coordination and motor function, affect, manner of relating, intellectual function, thought processes and content, and characteristics of play. Parental preference is not as relevant.

The nurse is caring for a preschooler with a mental disorder. The nurse identifies that the preschooler refuses to attend school and feels isolated. What does the nurse report to the primary health care provider about this preschooler?

"The child has ineffective coping skills." Children with intellectual developmental disorders have decreased ability in social, conceptual, and practical functioning. Ineffective coping skills are a sign of intellectual development disorders. Preschoolers with ineffective coping abilities find difficulty with peer interaction and lack interest in attending school. These conditions do not indicate impaired verbal communication, delayed growth and development, or risk of suicidal ideation. Impaired verbal communication is characterized by repetitive usage of language. Delayed growth and development is characterized by an inability to perform activities such as feeding, bathing, and dressing. Risk of suicidal ideation is characterized by signs such as difficulty in concentration and depression.

What should the nurse ask a three-year-old child while assessing the child's relationship with his or her parents?

"Would you draw me a picture of your family?" The nurse is performing an assessment of a three-year-old child so the nurse should ask the child to interact using play activities, drawings, and puppets. The child may be too young to give verbal answers to the nurse's questions. Thus, the nurse should ask the child to draw a picture of the family. This picture would help the nurse to understand the child's perception of the family. Asking the child about who helps in studies, about family vacations, and asking the child whom the child relies on the most would not be appropriate to ask a child of this age. The child lacks the maturity to answer these questions.

The family of a child diagnosed with attention deficient hyperactivity disorder (ADHD), inattentive type, is told the evaluation of their child's care will focus on symptom patterns and severity. What will the focus of evaluation be? Select all that apply.

Academic performance Activities of daily living Social relationships Personal perception For the family and child with ADHD, evaluation will focus on the symptom patterns and severity. For those with ADHD, inattentive type, the focus of evaluation will be academic performance, activities of daily living, social relationships, and personal perception. For those with ADHD, hyperactive-impulsive type or combined type, the focus will be on both academic and behavioral responses.

The nurse is caring for a child with autism spectrum disorder. The nurse identifies that the child has high levels of anxiety and has depression. Which measure taken by the nurse is most appropriate for treating the condition?

Administer a serotonin-specific reuptake inhibitor (SSRI). The goal of administering pharmacological agents is to reduce the level of anxiety and agitation. SSRIs are the most common choice of drug used for treating autism spectrum disorders. These drugs promote tolerance in patients to minimize further complications of the disorder. Anticonvulsants, adrenolytic drugs, and nonstimulant selective norepinephrine reuptake inhibitors are not used for treating anxiety in autism disorders. Anticonvulsants are used to treat aggressive behavior in children with attention deficit hyperactivity disorder. Adrenolytic drugs are used for treating agitation in attention deficit hyperactive patients. Nonstimulant selective norepinephrine reuptake inhibitors are used to treat side effects caused by antistimulants.

Based on knowledge of medications approved to treat Tourette's disorder, the nurse will prepare medication teaching on which class of medication?

Antipsychotics

A nurse counsels the parents of a five-year-old child diagnosed with severe autism spectrum disorder (ASD). When suggesting activities, which activity is most likely to engage this child?

Assembling and disassembling a simple toy, alone A child with ASD has severe impairments in social interactions and communication skills, often accompanied by stereotypical behavior, interests, and activities. Assembling and disassembling a simple toy alone would be an engaging activity for this child because of its repetitive nature. Play with other children will be difficult, especially for this young child with a severe disorder; solitary activities are better suited to this child.

A nurse develops a plan of care for a teenager newly admitted to a residential care program who is diagnosed with attention deficit hyperactivity disorder. The teenager has poor judgment, high risk-taking behaviors, and impulsivity. Which intervention has the highest priority?

Assign a staff member to one-to-one observation until the treatment team determines the teenager is no longer at risk for harm Safety is the priority. This teenager needs constant supervision until the team determines the risk for harm has dissipated. No-harm contracts have variable success and do not ensure supervision of this patient. It is important for the nurse to dialogue with the teenager, but safety has a higher priority. Locked seclusion is inappropriate and presents additional risks for injury.

A social behavior that is often a result of a child having been abused is

Bullying of others Children who have experienced abuse are at risk for identifying with their aggressor and may act out, bully others, become abusers, or develop dysfunctional interpersonal relationships in adulthood

The diagnosis of impaired intellectual functioning is supported when a child diagnosed with intellectual development disorders (IDD)

Cannot put together a five-piece jigsaw puzzle IDD, previously called mental retardation, are characterized by deficits in reasoning, problem solving, planning, judgment, abstract thinking, and academic ability compared with same-age peers.

During an assessment, the nurse finds that a patient says "wabbit" for "rabbit" and omits most of the sounds. Which neurodevelopmental disorder is the patient likely to have?

Communication disorder Patients having communication disorder often have problems with making sounds. They tend to distort, add, or omit some sounds. They often lack fluency while speaking and may repeat the words due to stammering. In intellectual development disorder, patients have problems in intellectual functioning and are unable to reason and judge in age-appropriate activities. In learning disorder, patients have reduced reading and writing skills. They have difficulty in doing mathematics and expressing their emotions. Patients suffering from attention deficit hyperactivity disorder have reduced attention and are often impulsive and hyperactive.

When a child demonstrates a temperament that prompts the mother to say, "She is just so different from me; I just can't seem to connect with her," the nurse will

Counsel the mother regarding ways to better bond with her child All people have temperaments, and the fit between the child and parent's temperament is critical to the child's development. The caregiver's role in shaping that relationship is of primary importance, and the nurse can intervene to teach parents ways to modify their behaviors to improve the interaction.

What statement is true regarding children diagnosed with specific learning disorders? Select all that apply.

Diagnosis generally is made during the school years. Learning disabilities are associated with poor reading, writing, or math skills. Diagnosis involves a series of assessment evaluations. Poor self-esteem is a common long-term outcome associated with learning disorders Children with specific learning disorders are identified during the school years. A learning disorder is diagnosed when a child demonstrates persistent difficulty in the acquisition of reading (dyslexia), mathematics (dyscalculia), or written expression (dysgraphia), and their performance is well below the expected performance of their peers. Diagnosis of a learning disorder is made through the evaluation of multiple assessments, including formal psychological evaluations, and is not explained better in the context of another mental illness. Long-term outcomes for children with learning disorders include low self-esteem, poor social skills, higher rates of school dropout, difficulties with attaining and maintaining employment, and poorer social adjustment. Such a diagnosis is not dependent on a comorbid mental health condition.

The nurse's concern about a 12-year-old living in a poor inner city neighborhood becoming involved in gang activity is based on the understanding that this age group

Has limited decision-making skills and often looks up to older peers The targeted age group for gang initiation seems to be 11to13, a time of particular developmental vulnerability. Decision-making capacities are not fully formed at this stage, and this group may look up to older peers for status and belonging.

Which impairment is the characteristic feature of a child with autism?

Impaired social interaction Every child with autism has impaired social interaction. Impaired vision may coexist with autism but is not a feature indicating autism. Impaired motor control is indicative of cerebral palsy. Autism may or may not accompany motor deficits. Impaired sensory perception also may not be associated with autism.

When preparing to assess a 4-year-old child to help rule out a neurodevelopmental disorder, the nurse bases interventions on the understanding that

Language skills are limited at that age Younger children are more difficult to diagnose than older children because of their limited language skills and cognitive and emotional development.

Which medication would the nurse most likely include when educating the parents of a child diagnosed with attention deficit hyperactivity disorder?

Methylphenidate (Ritalin) Central nervous system stimulants, such as methylphenidate, are used to treat attention deficit hyperactivity disorder.

A child in the pediatric facility shows disruptive behavior and is very likely to harm other children. What does the nurse do in this situation?

Lock the child up in a seclusion room In this situation, the nurse should ensure the safety of the other children in the facility. Moreover, the nurse should take the step that is least restrictive to the child. Thus, the nurse should seclude the child who is trying to harm other children. The child has disruptive behavior, thus the child is unlikely to listen to the nurse's instructions. Instructing the child to remain calm would be of no use. Seclusion is believed to be less restrictive than using physical restraints, therefore the nurse should not use physical restraint for this child. The child displays violent behavior so in this situation it is more important to control the child rather than telling other patients to ignore the child's behavior.

Which drug is prescribed to block the euphoric responses arising due to stereotypal movements in tic disorder?

Naltrexone (Revia) Naltrexone (Revia) is an opioid antagonist drug that blocks the euphoric responses arising due to stereotypal movements in tic disorder. Olanzapine (Zyprexa) is used to reduce harmful behavior in children with autism. Aripiprazole (Abilify), a conventional antipsychotic drug, is used to treat tics associated with Tourette's disorder. Methylphenidate (Ritalin) is a psychostimulant drug used for treatment of attention deficit hyperactivity disorder.

Which intervention would be the most important to teach the caregivers of a 9-year-old child diagnosed with attention deficit hyperactivity disorder (ADHD)?

Parenting skills Families of children diagnosed with attention deficit hyperactivity disorder are given support in using parenting skills. They are taught techniques for modifying behavior, monitoring medication effects, collaborating with teachers to foster academic success, and setting up a home environment that is consistent, structured, and nurturing and that promotes achievement of normal developmental milestones. Most children with attention deficit hyperactivity disorder are able to verbally express themselves, so speech therapy is not needed. Aversive therapy refers to negative consequences for undesired behavior, but this child needs positive and negative rewards. Cognitive-behavioral therapy is an advanced practice intervention.

Which factor can reduce the vulnerability of a child to etiological influences predisposing to the development of psychopathology?

Resilience Resilience refers to developing and using certain characteristics that help a child to handle the stresses of a difficult childhood without developing mental problems. Resilient children can adapt to changes in the environment, form nurturing relationships with adults other than their parents, distance themselves from the emotional chaos of the family, and have social intelligence and the ability to use problem-solving skills.

A nursing diagnosis that should be considered for a child with attention deficit hyperactivity disorder is

Risk for injury The child's marked hyperactivity puts him or her at risk for injury from falls, bumping into objects, impulsively operating equipment, pulling heavy objects off shelves, and so forth.

What are the familial risk factors associated with child psychiatric disorders? Select all that apply.

Severe marital discord Low socioeconomic status Foster care placement The familial risk factors associated with child psychiatric illness include severe marital discord, low socioeconomic status, and foster care placement. Such children are more likely to develop psychiatric disorders as they have ineffective coping skills. Children belonging to a single-child family tend to be well looked after and thus are unlikely to develop psychiatric problems. A child belonging to a nuclear family would be given more attention compared to a child who belongs to a large family. Thus these children are less susceptible to developing psychiatric illnesses.

A nurse talks with the parents of a child diagnosed with attention deficit hyperactivity disorder. Amphetamine salts (Adderall) have been prescribed for the child. The nurse should teach the parents to monitor for which side effects? Select all that apply.

Tachycardia Insomnia Headache Insomnia is a common side effect, as well as appetite suppression, headache, tachycardia, abdominal pain, and lethargy. Hypertension, rather than hypotension, may occur.

Which statement describes a resilient child?

The child is adaptable to changes in the environment Resilience refers to an individual's ability to handle stressful environments. A child who has the ability to adapt to the external environment is referred to as a resilient child. A resilient child is not stubborn but shows good problem-solving skills. A resilient child is not aggressive and tends to stay away from emotional chaos. Such children are able to adjust well with other people even when their parents are not available.

A workshop was conducted by the American Psychiatric Nurses Association (APNA). The nurses explained different psychoanalytical therapeutic tools to the teachers to analyze a child's behavior. Which method followed by the teacher in the class shows effective learning?

The teacher should encourage the child to theme- draw. Drawing is a nonverbal means of expressing emotions. Children should be encouraged to draw themes which reflect their surroundings and mental condition. When reading a book, the child unconsciously identifies with the characters. It helps in cognitive development. A child should never be forced to read a book. Playing helps a child express the thoughts and emotions which the child cannot express verbally. Music can be helpful in treating psychological and physical disorders. Music helps to have an insight into the child's emotions and thoughts. So the teacher should play music daily in the class.

What are the interventions that focus on the recognized barriers to the identification and treatment of children and adolescents demonstrating symptoms of mental health disorders? Select all that apply.

Working with the local school board to identify screening opportunities for adolescents. Researching policies regarding interdisciplinary coordination of mental health services. Fundraising for a mental health clinic that focuses on providing services to children. Lobbying the state regarding the revising of the reimbursement process for mental health services The barriers to assessment and treatment of this population include: lack of consensus and clarity about conditions for screening children; lack of coordination among multiple systems; lack of community-based resources and long waiting lists for services; lack of mental health providers; and cost and inadequate reimbursement. Identifying cultural groups at risk for mental illness would not be recognized as a barrier.