Psych ch 33

Outcome criteria for the client with ODD

-Complies with treatment by participating in therapies without negativism -Accepts responsibility for his or her part in the problem -Takes direction from staff without becoming defensive -Does not manipulate other people -Verbalizes positive aspects about self -Interacts with others in an appropriate manner

Environmental influences of ADHD

-Environmental Lead = Studies continue to provide evidence of the adverse effects of elevated body levels of lead on cognitive and behavioral development in children -Diet Factors

Outcome criteria for clients with ASD

-Exhibits no evidence of self-harm -Interacts appropriately with at least one staff member -Demonstrates trust in at least one staff member -Is able to communicate so that he or she can be understood by at least one staff member -Demonstrates behaviors that indicate he or she has begun the separation/individuation process

Outcome criteria for clients with ID (short and long term)

-Has experienced no physical harm -Has had self-care needs fulfilled -Interacts with others in a socially appropriate manner -Has maintained anxiety at a manageable level -Is able to accept direction without becoming defensive -Demonstrates adaptive coping skills in response to stressful situations

Outcome criteria for clients with ADHD

-Has experienced no physical harm -Interacts with others appropriately -Verbalizes positive aspects about self -Demonstrates fewer demanding behaviors -Cooperatives with staff in an effort to complete assigned tasks

Nursing dx for the client with ODD

-Noncompliance with therapy related to negative temperament, denial of problems, underlying hostility -Defensive coping related to retarded ego development, low self-esteem, unsatisfactory parent/child relationship -Low self-esteem related to lack of positive feedback, retarded ego development -Impaired social interaction related to negative temperament, underlying hostility, manipulation of others

Family dynamics that contribute to conduct disorder

-Parental rejection, neglect, or severe physical and verbal aggression -Inconsistent or harsh, punitive discipline -Parental sociopathy -Lack of parental supervision -Frequent changes in residence -Economic stressors -Parents with antisocial personality disorder, severe psychopathology, and/or alcohol/other substance dependence -Marital conflict and divorce (particularly with persistent hostility)

Nursing dx for the client with ID

-Risk for injury related to altered physical mobility or aggressive behavior -Self-care deficit related to altered physical mobility or lack of maturity -Impaired verbal communication related to developmental alteration -Impaired social interaction related to speech deficiencies or difficulty adhering to conventional social behavior -Delayed growth and development related to isolation from significant others, inadequate environmental stimulation, genetic factors -Anxiety (moderate to severe) related to hospitalization and absence of familiar surroundings -Defensive coping related to feelings of powerlessness and threat to self-esteem -Ineffective coping related to inadequate coping skills secondary to developmental delay

Nursing dx associated with ADHD

-Risk for injury related to impulsive and accident-prone behavior and the inability to perceive self-harm -Impaired social interaction related to intrusive and immature behavior -Low self-esteem related to dysfunctional family system and negative feedback -Noncompliance with task expectations related to low frustration tolerance and short attention span

Nursing dx for the client with ASD

-Risk for self-mutilation or self injury related to neurological, cognitive, or social deficits -Impaired social interaction related to inability to trust; neurological alterations, evidenced by lack of responsiveness to, or interest in, people -Impaired verbal communication related to withdrawal into the self; neurological alterations, evidenced by inability or unwillingness to speak; lack of nonverbal expression -Disturbed personal identity related to neurological alterations; delayed developmental stage, evidenced by difficulty separating own physiological and emotional needs and personal boundaries from those of others

Patterns of family dynamics (ODD)

-There is the combination of a strong-willed child with a reactive and high-energy temperament and parents who are authoritarian rather than authoritative. -The parents become frustrated with the strong-willed child who does not obey and increase their attempts to enforce authority. -The child reacts to the excessive parental control with anger and increased self-assertion.

Predisposing factors

-genetics -biochemical theory (particularly dopamine, norepinephrine, and possibly serotonin, but still under investigation) -Anatomical Influences (decreased volume and activity in the prefrontal cortex) -Prenatal, Perinatal, and Postnatal Factors (Maternal smoking during pregnancy has been linked to hyper-kinetic-impulsive behavior in offspring; Intrauterine exposure to toxic substances, including alcohol, can produce effects on behavior; Fetal alcohol syndrome includes hyperactivity, impulsivity, and inattention, as well as physical anomalies.)

Predisposing factors for ASD

-neuro implications (total brain volume, size of the amygdala, and the size of striatum have all been identifies as enlarged) -genetics -prenatal and perinatal influences (Some of the prenatal risk factors associated with development of ASD include advanced parental age, fetal exposure to valproate, gestational diabetes, and gestational bleeding; include low birth weight, obstetrical complications (particularly those associated with neonatal hypoxia), hyperbilirubinemia, congenital malformation, and ABO or Rh factor incompatibilities; and Exposure to environmental toxins, including air pollution and pesticides, showed the strongest links to ASD when it occurred during preconception, gestational, and early childhood stages)

Nursing interventions for impaired social interaction associated with ASD

1. Assign a limited number of caregivers to child. Ensure that warmth, acceptance, and availability are conveyed. 2. Provide child with familiar objects, such as familiar toys or a blanket. Support child's attempts to interact with others. 3. Give positive reinforcement for eye contact with something acceptable to child (e.g., food, familiar object). Gradually replace with social reinforcement (e.g., touch, smiling, hugging).

Nursing interventions for disturbed personal identity associated with ASD

1. Assist child to recognize separateness during self-care activities, such as dressing and feeding. 2. Assist child in learning to name own body parts. This can be facilitated by the use of mirrors, drawings, and pictures of the child. Encourage appropriate touching of, and being touched by, others.

Nursing interventions for impaired social interaction associated with separation anxiety disorder

1. Attend groups with child and support efforts to interact with others. Give positive feedback. 2. Develop a trusting relationship with client. 3. Help client set small personal goals (e.g., "Today I will speak to one person I don't know").

Nursing interventions for low self esteem associated with tourrette's

1. Convey unconditional acceptance and positive regard. 2. Set limits on manipulative behavior. Take caution not to reinforce manipulative behaviors by providing desired attention. 3. Help client understand that he or she uses manipulation to try to increase own self-esteem. 4. If client chooses to suppress tics in the presence of others, provide a specified "tic time" during which he or she "vents" tics, feelings, and behaviors (alone or with staff).

Nursing interventions for risk for injury associated with ID

1. Create a safe environment for client. 2. Ensure that small items are removed from area where client will be ambulating and that sharp items are out of reach. 3. Store items that client uses frequently within easy reach. 4. Pad side rails and headboard of client with history of seizures. 5. Prevent physical aggression and acting out behaviors by learning to recognize signs that client is becoming agitated.

Nursing interventions for impaired social interactions associated with ADHD

1. Develop a trusting relationship with child. Convey acceptance of child separate from the unacceptable behavior. 2. Discuss with client those behaviors that are and are not acceptable 3. Provide group situations for client.

Nursing interventions for impaired social interaction associated with conduct disorder

1. Develop a trusting relationship with client. Convey acceptance of the person separate from the unacceptable behavior. 2. Discuss with client which behaviors are and are not acceptable. Describe in matter-of-fact manner the consequence of unacceptable behavior. Follow through. 3. Provide group situations for client.

Nursing interventions for impaired social interactions associated with tourrette's

1. Develop a trusting relationship with client. Convey acceptance of the person separate from the unacceptable behavior. 2. Discuss with client which behaviors are and are not acceptable. Describe in matter-of-fact manner the consequences of unacceptable behavior. Follow through. 3. Provide group situations for client

Nursing interventions for ineffective coping associated with separation anxiety

1. Encourage child or adolescent to discuss specific situations in life that produce the most distress and describe his or her response to these situations. Include parents in the discussion. 2. Help child or adolescent who is perfectionistic to recognize that self-expectations may be unrealistic. 3. Encourage parents and child to identify more adaptive coping strategies that child could use in the face of anxiety that feels overwhelming. Practice through role-play.

Nursing interventions for risk for injury associated with ADHD

1. Ensure that client has a safe environment. Remove objects from immediate area on which client could injure self as a result of random, hyperactive movements. 2. Identify deliberate behaviors that put child at risk for injury. Institute consequences for repetition of this behavior. 3. If there is risk of injury associated with specific therapeutic activities, provide adequate supervision and assistance, or limit client's participation if adequate supervision is not possible.

Nursing interventions for low self esteem associated with ADHD

1. Ensure that goals are realistic. 2. Plan activities that provide opportunities for success. 3. Convey unconditional acceptance and positive regard 4. Offer recognition of successful endeavors and positive reinforcement for attempts made.

Nursing interventions for anxiety associated with separation anxiety disorder

1. Establish an atmosphere of calmness, trust, and genuine positive regard 2. Assure client of his or her safety and security. 3. Explore child's or adolescent's fears of separating from the parents. Explore with parents possible fears they may have of separation from child. 4. Help parents and child initiate realistic goals (e.g., child to stay with sitter for 2 hours with minimal anxiety; or, child to stay at friend's house without parents until 9 p.m. without experiencing panic anxiety). 5. Give, and encourage parents to give, positive reinforcement for desired behaviors.

Nursing interventions for impaired social interactions associated with ODD

1. Explain to client about passive-aggressive behavior. Explain how these behaviors are perceived by others. Describe which behaviors are not acceptable and role-play more adaptive responses. Give positive feedback for acceptable behaviors.

Nursing interventions for defensive coping associated with ODD

1. Help client recognize that feelings of inadequacy provoke defensive behaviors, such as blaming others for problems, and the need to "get even." 2. Provide immediate, nonthreatening feedback for passive-aggressive behavior. 3. Help identify situations that provoke defensiveness, and practice through role-play more appropriate responses. 4. Provide immediate positive feedback for acceptable behaviors.

Nursing interventions for self-care deficits associated with ID

1. Identify aspects of self-care that may be within client's capabilities. Work on one aspect of self-care at a time. Provide simple, concrete explanations. Offer positive feedback for efforts. 2. When one aspect of self-care has been mastered to the best of client's ability, move on to another. Encourage independence but intervene when client is unable to perform.

Nursing interventions for impaired verbal communication associated with ASD

1. Maintain consistency in assignment of caregivers. 2. Anticipate and fulfill child's needs until communication can be established. 3. Seek clarification and validation. 4. Give positive reinforcement when eye contact is used to convey nonverbal expressions.

Nursing interventions for impaired verbal communication associated with ID

1. Maintain consistency of staff assignment over time. 2. Anticipate and fulfill client's needs until satisfactory communication patterns are established. Learn (from family, if possible) special words client uses that are different from the norm. Identify nonverbal gestures or signals that client may use to convey needs if verbal communication is absent. Practice these communications skills repeatedly.

Nursing interventions for risk for other directed violence associated with conduct disorder

1. Observe client's behavior frequently through routine activities and interactions 2. Redirect violent behavior with physical outlets for suppressed anger and frustration. 3. Encourage client to express anger, and act as a role model for appropriate expression of anger. 4. Explore child's perceptions and feelings about contributing factors and triggers for anger and violent behavior. 5. Ensure that a sufficient number of staff is available to indicate a show of strength if necessary. 6. Administer tranquilizing medication, if ordered, or use mechanical restraints or isolation room only if situation cannot be controlled with less restrictive means.

Nursing interventions for risk for self-directed or other directed violence associated with tourrette's

1. Observe client's behavior frequently through routine activities and interactions. Become aware of behaviors that indicate a rise in agitation. (Stress commonly increases tic behaviors) 2. Monitor for self-destructive behavior and impulses. A staff member may need to stay with client to prevent self-mutilation. 3. A staff member may need to stay with client to prevent self-mutilation. 4. Provide hand coverings and other restraints that prevent client from self-mutilative behaviors. 5. Redirect violent behavior with physical outlets for frustration.

Nursing interventions for noncompliance (with task expectations) associated with ADHD

1. Provide an environment for task efforts that is as free of distractions as possible. 2. Provide assistance on a one-to-one basis, beginning with simple, concrete instructions. 3. Ask client to repeat instructions to you. 4. Establish goals that allow client to complete a part of the task, rewarding each step-completion with a break for physical activity 5. Gradually decrease the amount of assistance given while assuring client that assistance is still available if deemed necessary.

Nursing interventions for impaired social interactions

1. Remain with client during initial interactions with others on the unit. 2. Explain to other clients the meaning behind some of client's non-verbal gestures and signals. Use simple language to explain to client which behaviors are acceptable and which are not. Establish a procedure for behavior modification with rewards for appropriate behaviors and aversive reinforcement for inappropriate behaviors.

Nursing interventions for noncompliance with therapy associated with ODD

1. Set forth a structured plan of therapeutic activities. Start with minimum expectations and increase as client begins to manifest evidence of compliance. 2. Establish a system of rewards for compliance with therapy and consequences for noncompliance. 3. Convey acceptance of client separate from the undesirable behaviors being exhibited

Nursing interventions for risk for self-mutilation associated with ASD

1. Work with child on a one-to-one basis. 2. Try to determine if the self-mutilative behavior occurs in response to increasing anxiety, and if so, to what the anxiety may be attributed. 3. Try to intervene with diversion or replacement activities and offer self to child as anxiety level starts to rise 4. Diversion and replacement activities may provide needed feelings of security and substitute for self-mutilative behaviors

Autism Spectrum Disorder (ASD)

A heterogenous group of neurodevelopmental syndromes characterized by a wide range of communication impairments and restricted, repetitive behaviors encompasses a broad spectrum of associated diagnoses that included autistic disorder, Rett's disorder, childhood disintegrative disorder, pervasive developmental disorder not otherwise specified, and Asperger's disorder The diagnosis is adapted to each individual by clinical specifiers (e.g., level of severity, verbal abilities) and associated features (e.g., known genetic disorders, epilepsy, intellectual disability) ASD is characterized by a withdrawal of the child into an internal fantasy world of his or her own creation The child has abnormal or impaired development in social interaction and communication and a restricted repertoire of activity and interests, some of which may be considered somewhat bizarre.

Diagnostic criteria for conduct disorder

A. AGGRESSION TO PEOPLE AND ANIMALS 1. Often bullies, threatens, or intimidates others. 2. Often initiates physical fights. 3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun). 4. Has been physically cruel to people. 5. Has been physically cruel to animals. 6. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery). 7. Has forced someone into sexual activity. DESTRUCTION OF PROPERTY 1. Has deliberately engaged in fire setting with the intention of causing serious damage. 2. Has deliberately destroyed others' property (other than by fire setting). DECEITFULNESS OR THEFT 1. Has broken into someone else's house, building, or car. 2. Often lies to obtain goods or favors or to avoid obligations (i.e., "cons" others). 3. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery). SERIOUS VIOLATIONS OF RULES 1. Often stays out at night despite parental prohibitions, beginning before age 13 years. 2. Has run away from home overnight at least twice while living in parental or parental surrogate home, or once without returning for a lengthy period. 3. Is often truant from school, beginning before age 13 years. B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning. C. If the individual is age 18 years or older, criteria are not met for antisocial personality disorder.

Diagnostic Criteria for Tourette's Disorder

A. Both multiple motor and one or more vocal tics have been present at some time during the illness, although not necessarily concurrently. B. The tics may wax and wane in frequency but have persisted for more than 1 year since first tic onset. C. Onset is before age 18 years. D. The disturbance is not attributable to the physiological effects of a substance (e.g., cocaine) or another medical condition (e.g., Huntington's disease, postviral encephalitis).

Diagnostic Criteria for Separation Anxiety Disorder

A. Developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached, as evidenced by at least three of the following: 1. Recurrent excessive distress when anticipating or experiencing separation from home or major attachment figures. 2. Persistent and excessive worry about losing major attachment figures or about possible harm to them, such as illness, injury, disasters, or death. 3. Persistent and excessive worry about experiencing an untoward event (e.g., getting lost, being kidnapped, having an accident, becoming ill) that causes separation from a major attachment figure. 4. Persistent reluctance or refusal to go out, away from home, to school, to work, or elsewhere because of fear of separation. 5. Persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings. 6. Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure. 7. Repeated nightmares involving the theme of separation. 8. Repeated complaints of physical symptoms (e.g., headaches, stomachaches, nausea, vomiting) when separation from major attachment figures occurs or is anticipated.

Diagnostic Criteria for Attention-Deficit/Hyperactivity Disorder

A. Inattention: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities. Note: The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), at least five symptoms are required. a. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate). b. Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or reading lengthy reading). c. Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction). d. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked). e. Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized, work; has poor time management; fails to meet deadlines). f. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers). g. Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, or mobile telephones). h. Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts). i. Is often forgetful in daily activities (e.g., chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments). Hyperactivity and Impulsivity: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities. Note: The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or a failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), at least five symptoms are required.

Diagnostic Criteria for Autism Spectrum Disorder

A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive): 1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions. 2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication. 3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers. B. Restricted, repetitive patterns of behavior, interests, or activities 1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases). 2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day) 3. Highly restricted, fixated interests that are abnormal in intensity or focus (strong attachment with unusual objects) C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life) D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning

Diagnostic Criteria for Oppositional Defiant Disorder

A. pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least four symptoms from any of the following categories, and exhibited during interaction with at least one individual that is not a sibling. ANGRY/IRRITABLE MOOD 1. Often loses temper. 2. Is often touchy or easily annoyed. 3. Is often angry and resentful. ARGUMENTATIVE/DEFIANT BEHAVIOR 1. Often argues with authority figures or, for children and adolescents, with adults. 2. Often actively defies or refuses to comply with requests from authority figures or with rules. 3. Often deliberately annoys others. 4. Often blames others for his or her mistakes or misbehavior. VINDICTIVENESS 1. Has been spiteful or vindictive at least twice within the past 6 months. B. The disturbance in behavior is associated with distress in the individual or others in his or her immediate social context (e.g., family, peer group, work colleagues), or it impacts negatively on social, educational, occupational, or other important areas of functioning.

Nursing dx for a client with separation anxiety disorder

Anxiety (severe) related to family history, temperament, overattachment to parent, negative role modeling Ineffective coping related to unresolved separation conflicts and inadequate coping skills evidenced by numerous somatic complaints Impaired social interaction related to reluctance to be away from attachment figure

Medications for ADHD

CNS stimulants (first line of treatment): -Amphetamines (dextroamphetamine, lisdexamfetamine, methamphetamine, and mixtures): Cause the release of norepinephrine from central noradrenergic neurons. At higher doses, dopamine may be released in the mesolimbic system -Methylphenidate and dexmethylphenidate: Block the reuptake of norepinephrine and dopamine into the presynaptic neuron and increase the release of these monoamines into the extraneuronal space Alpha agonist: (clonidine, guanfacine): Stimulate central alpha-adrenoreceptors in the brain, resulting in reduced sympathetic outflow from the CNS

Tourette's: alpha agonists medications

Clonidine (Catapres) and guanfacine (Tenex, Intuniv) are alpha-adrenergic agonists that are approved for use as antihypertensive agents These medications may be used for treatment of Tourette's disorder because of their favorable side-effect profile and because they are often effective for comorbid symptoms of ADHD, anxiety, and insomnia. dry mouth, sedation, headaches, fatigue, and dizziness or postural hypotension Guanfacine is longer lasting and less sedating than clonidine, but its efficacy in reducing tics is controversial They should not be discontinued abruptly; to do so could result in symptoms of nervousness, agitation, tremor, and a rapid rise in blood pressure.

Intellectual Disability (ID)

DSM 5 defines intellectual disability as a "disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social, and practical domains" Onset of intellectual and adaptive deficits occurs during the developmental period Level of severity (mild, moderate, severe, or profound) is based on adaptive functioning within the three domains General intellectual functioning is measured by both clinical assessment and an individual's performance on intelligence quotient (IQ) tests Adaptive functioning refers to the person's ability to adapt to the requirements of daily living and the expectations of his or her age and cultural group.

How do the disruptions in embryonic development contribute to ID?

Damages may occur in response to toxicity associated with maternal ingestion of alcohol or other drugs. fetal alcohol syndrome Maternal illnesses and infections during pregnancy (e.g., rubella, cytomegalovirus) and complications of pregnancy (e.g., toxemia, uncontrolled diabetes) also can result in congenital intellectual disability

Neurotransmitter functions in ADHD

Deficits in norepinephrine and dopamine have both been implicated in the inattention, impulsiveness, and hyperactivity associated with ADHD. It has been suggested that alterations in serotonin may be related to the disinhibition and impulsivity observed in children with ADHD

Family dynamic that contributes to ADHD

Disorganized or chaotic environments or a disruption in family equilibrium may contribute to ADHD in some individuals. non-intact family, young maternal age at birth of the target child, paternal history of antisocial behavior, and maternal depression.

ASD: restricted activities and interests

Even minor changes in the environment are often met with resistance or sometimes with agitated irritability Attachment to or extreme fascination with objects that move or spin (e.g., fans) is common Stereotyped body movements (hand-clapping, rocking, whole-body swaying) and verbalizations (repetition of words or phrases) are typical. eating only a few specific foods or consuming an excessive amount of fluids Self-injurious behaviors, such as head banging or biting the hands or arms

Hyperactivity

Excessive psychomotor activity that may be purposeful or aimless, accompanied by physical movements and verbal utterances that are usually more rapid than normal. Inattention and distractibility are common with hyperactive behavior.

Predisposing factors for tourrette's disorder?

Genetics = (genetic studies suggest that ADHD and obsessive-compulsive disorder (OCD) are genetically related to Tourette's disorder) Biochemical = The effectiveness of antipsychotic medication (particularly haloperidol and fluphenazine) in suppressing tics also supports neurotransmitter involvement in Tourette's disorder Structural factors

Outcome criteria for conduct disorder

Has not harmed self or others Interacts with others in a socially appropriate manner Accepts direction without becoming defensive Demonstrates evidence of increased self-esteem by discontinuing exploitative and demanding behaviors toward others

Outcome criteria for the client with tourrette's

Has not harmed self or others Interacts with staff and peers in an appropriate manner Demonstrates self-control by managing tic behavior Follows rules of the unit without becoming defensive Verbalizes positive aspects about self

Severe characteristics of ID

IQ: 20-34 May be trained in elementary hygiene skills Requires complete supervision. Unable to benefit from academic or vocational training Minimal verbal skills. Wants and needs often communicated by acting-out behaviors. Poor psychomotor development. Able to perform only simple tasks under close supervision

Moderate characteristics of ID

IQ: 35-49 Can perform some activities independently. Requires supervision. Capable of academic skill to second-grade level. As adult may be able to contribute to own support in sheltered workshop. May experience some limitation in speech communication. Difficulty adhering to social convention may interfere with peer relationships. Motor development is fair. Vocational capabilities may be limited to unskilled gross motor activities.

Mild characteristics of ID

IQ: 50-70 Capable of independent living with assistance during times of stress. Capable of academic skills to sixth-grade level. As adult can achieve vocational skills for minimum self-support Capable of developing social skills. Functions well in a structured, sheltered setting Psychomotor skills usually not affected,

Profound characteristics of ID

IQ: <20 No capacity for independent functioning. Requires constant aid and supervision. Unable to profit from academic or vocational training. May respond to minimal training in self-help if presented in the close context of a one-to-one relationship. Little, if any, speech development. No capacity for socialization skills. Lack of ability for both fine and gross motor movements. Requires constant supervision and care. May be associated with other physical disorders.

Diagnostic criteria for ID

Intellectual disability (intellectual developmental disorder) is a disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social, and practical domains. The following three criteria must be met: A. Deficits in intellectual functions, such as reasoning, problem-solving, planning, abstract thinking, judgment, academic learning, and learning from experience, confirmed by both clinical assessment and individualized, standardized intelligence testing. B. Deficits in adaptive functioning that result in failure to meet developmental and sociocultural standards for personal independence and social responsibility. Without ongoing support the adaptive deficits limit functioning in one or more activities of daily life, such as communication, social participation, and independent living, across multiple environments, such as home, school, work, and community. C. Onset of intellectual and adaptive deficits during the developmental period.

Outcome criteria for separation anxiety disorder

Is able to maintain anxiety at manageable level Demonstrates adaptive coping strategies for dealing with anxiety when separation from attachment figure is anticipated

psychopharmacology

Medication should never be the sole method of treatment. It is important for families to understand that there is no way to "give him a pill and make him well." The importance of the psychosocial therapies cannot be overstressed The beneficial effects of the medications promote improved coping ability, which in turn enhances the intent of the psychosocial therapy.

Nursing assessment for children with ID

Nurses should assess and focus on each client's strengths and individual abilities. Knowledge regarding level of independence in the performance of self-care activities is essential to the development of an adequate plan for nursing care. The degree of severity of intellectual disability may be measured by the client's IQ level mild, moderate, severe, and profound

Family influences and ODD

Opposition during various developmental stages is both normal and healthy Children first exhibit oppositional behaviors at around 10 or 11 months of age, again as toddlers between 18 and 36 months of age, and finally during adolescence. Pathology is considered only when the developmental phase is prolonged or when there is overreaction in the child's environment to his or her behavior. Some parents interpret average or increased level of developmental oppositional behavior as hostility and a deliberate effort on the part of the child to be in control

Temperament

Personality characteristics that define an individual's mood and behavioral tendencies. The sum of physical, emotional, and intellectual components that affect or determine a person's actions and reactions.

Peer relationships with conduct disorder

Poor academic performance and social maladaptation often lead to affiliations with a deviant peer group In addition to evidence that engaging in risk-taking behaviors can yield reinforcement on a social level (acceptance within a peer group)

Nursing dx for clients with conduct disorder

Risk for other-directed violence related to characteristics of temperament, peer rejection, negative parental role models, dysfunctional family dynamics Impaired social interaction related to negative parental role models, impaired peer relations leading to inappropriate social behaviors Defensive coping related to low self-esteem and dysfunctional family system Low self-esteem related to lack of positive feedback and unsatisfactory parent-child relationship

Nursing dx for the client with Tourette's

Risk for self-directed or other-directed violence related to low tolerance for frustration Impaired social interaction related to impulsiveness and oppositional and aggressive behavior Low self-esteem related to embarrassment associated with tic behaviors

Common side effects for CNS stimulants

Side effects of CNS stimulants include restlessness, insomnia, headache, palpitations, weight loss, suppression of growth in children (with long-term use), increased blood pressure, abdominal pain, anxiety, tolerance, and physical and psychological dependence.

Biological influences in ODD

Some studies have identified genetic influences in the establishment of a child's temperament, but there is not clear evidence of this connection in ODD having a temperament in which the child has difficulty regulating emotions and has low frustration tolerance is an identified risk factor for ODD

How are stressful life events associated with separation anxiety disorder?

Studies have shown a relationship between life events and the development of anxiety disorders. Significant change or loss often coincides with the development of the disorder Children of mothers who were stressed during pregnancy also appear to be at greater risk for developing separation anxiety disorder

Characteristics of tourrette's disorder

The motor tics of Tourette's disorder may involve the head, torso, and upper and lower limbs Initial symptoms may begin with a single motor tic, most commonly eye blinking, or with multiple symptoms Tics tend to first occur in the face and neck and progress downward to the torso and lower limbs over time Simple motor tics include movements such as eye blinking, neck jerking, shoulder shrugging, and facial grimacing The more complex motor tics include squatting, hopping, skipping, tapping, and retracing steps. The more complex motor tics include squatting, hopping, skipping, tapping, and retracing steps. repeating certain words or phrases out of context, repeating one's own sounds or words (palilalia), or repeating what others say (echolalia). are experienced as compulsive and irresistible but can be suppressed for varying lengths of time Tics are often worse during periods of stress or excitement and better during periods of calm, focused activity tics are diminished during sleep manifest difficulty with reading, writing, and arithmetic

Important info about children taking ADHD medications

The researchers found that children taking ADHD drugs (mostly stimulants) had a twofold higher risk of injury-related hospital admissions than among those not treated with ADHD drugs. They also found that children who were on ADHD drugs and psychotropic drugs such as antipsychotics and benzodiazepines had five times increased risk for injuries and hospital admissions than those who were on ADHD medication alone Amphetamines have been a common substance of abuse and demonstrate a high risk for dependence

What is the temperament of a child with separation anxiety disorder?

The temperamental traits of shyness and withdrawal in unfamiliar situations, have been shown to be associated with a higher risk of developing separation anxiety disorder [as well as other anxiety disorders]

Impulsiveness

The trait of acting without reflection and without thought to the consequences of the behavior. An abrupt inclination to act (and the inability to resist acting) on certain behavioral urges.

Family therapy

Therapy for children and adolescents must involve the entire family if problems are to be resolved. Parents should be involved in designing and implementing the treatment plan for the child and all other aspects of the treatment process. It provides an overall picture of the family life over several generations, including roles that various family members play and emotional distance between specific individuals The impact of disruptive behavior on family dynamics cannot be ignored. Family coping can become severely compromised by the chronic stress of dealing with a child with a behavior disorder.

ID and genetic factors

These factors include inborn errors of metabolism Also included are chromosomal disorders single-gene abnormalities,

Comorbidity of ADHD

They further identify that most children and adolescents with disruptive mood dysregulation disorder also meet criteria for ADHD Other comorbidities include conduct disorder, specific learning disorder, and intermittent explosive disorder identify that although bipolar mania and ADHD share many core features, such as distractibility, excessive talking, and hyperactivity, children with bipolar I disorder exhibit symptoms that wax and wane, whereas children with ADHD have more persistent, continuous symptoms.

Group therapy

This experience can be both gratifying and overwhelming, depending on the child. provides children and adolescents with the opportunity to interact within an association of their peers provides a number of benefits Appropriate social behavior often is learned from the positive and negative feedback of peers Opportunity is provided to learn to tolerate and accept differences in others, learn that it is acceptable to disagree, offer and receive support from others, and practice these new skills in a safe environment. It is also a way to learn from the experiences of others. Music therapy groups allow clients to express feelings through music, often when they are unable to express themselves in any other way. Art and activity/craft therapy groups allow individual expression through artistic means. Psychoeducational groups are very beneficial for adolescents Members are allowed to propose topics for discussion. The leader serves as teacher much of the time and facilitates discussion of the proposed topic.

Family influences towards separation anxiety disorder

anxiety disorders in children are related to an attachment issue with the mother Three family influences that have demonstrated an increased risk for anxiety disorders in children include parental overprotection, insecure parent-child attachment, and maternal depression Some parents may also transfer their fears and anxieties to their children through role-modeling a parent who becomes significantly fearful and apprehensive when confronted with unfamiliar circumstances, such as a job or residence change, teaches the child that this is an appropriate response.

Pharmacology interventions for ASD

are directed toward relief of targeted irritability symptoms such as aggression, hyperactivity self-harm, impulsivity, and temper tantrums risperidone & aripiprazole When administering risperidone, caution must be maintained concerning uncommon but serious possible side effects, including neuroleptic malignant syndrome, tardive dyskinesia, hyperglycemia, and diabetes. aripiprazole, the most frequently reported adverse events included sedation, fatigue, weight gain, vomiting, somnolence, and tremor.

Characteristics of ADHD

difficulties in performing age-appropriate tasks. are highly distractible and have extremely limited attention spans. They often shift from one uncompleted activity to another. Impulsivity, or deficit in inhibitory control, is also common. They demonstrate behaviors that inhibit acceptable social interaction They are disruptive and intrusive in group endeavors Some children with ADHD are very aggressive or oppositional, whereas others exhibit more regressive and immature behaviors Low frustration tolerance and outbursts of temper are common. have boundless energy, exhibiting excessive levels of activity, restlessness, and fidgeting; Continuously running, jumping, wiggling, or squirming experience a greater than average number of accidents

Attention-deficit/Hyperactivity Disorder (ADHD)

essential behavior pattern: is one of inattention and/or hyperactivity and impulsivity These children are highly distractible and unable to contain stimuli. Motor activity is excessive, and movements are random and impulsive

Tourrette's: antipsychotics medications

haloperidol (Haldol) and pimozide (Orap), have been approved by the FDA for control of tics and vocal utterances associated with Tourette's disorder. highly effective in alleviating these symptoms They are often not the first-line choice of therapy, however, because of their propensity for severe adverse effects such as extrapyramidal symptoms, neuroleptic malignant syndrome, tardive dyskinesia, and electrocardiographic changes Atypical: risperidone (Risperdal), olanzapine (Zyprexa), or ziprasidone (Geodon), because of their more favorable side-effect profiles. These medications have a lower incidence of neurological side effects than the typical antipsychotics, although extrapyramidal symptoms have been observed with risperidone weight gain, metabolic side effects, and hyperprolactinemia

ASD: Impairment in social interaction

have difficulty forming interpersonal relationships with others They show little interest in people and often do not respond to others' attempts at interaction As infants, they may have an aversion to affection and physical contact As toddlers, the attachment to a significant adult may be either absent or manifested as exaggerated adherence behaviors In childhood, a lack of spontaneity is manifested in less cooperative play, less imaginative play, and fewer friendships Social interaction is further impaired by deficits in ability to accurately process others' feelings or affect. Higher-functioning children may recognize their difficulty with social skills even though they may desire friendship They found that the differential features in ASD were less extroversion, less openness to experience, increased inhibition, and increased compulsivity than among those with personality disorders.

What general medical conditions acquired in infancy/childhood that contributes to ID?

infections, such as meningitis and encephalitis; poisonings, such as from insecticides, medications, and lead; and physical trauma, such as head injuries, asphyxiation, and hyperpyrexia

How do pregnancy and perinatal factors contribute to ID?

intellectual disability are the result of circumstances that occur during pregnancy (e.g., fetal malnutrition, viral and other infections, and prematurity) or during the birth process trauma to the head incurred during the process of birth, placenta previa or premature separation of the placenta, and prolapse of the umbilical cord.

Behavioral therapy

is based on the concepts of classical conditioning and operant conditioning and is a common and effective treatment with disruptive behavior disorders such as ADHD, ODD, and conduct disorder rewards are given for appropriate behaviors and withheld when behaviors are disruptive or otherwise inappropriate. positive reinforcements encourage repetition of desirable behaviors and aversive reinforcements (punishments) discourage repetition of undesirable behaviors. the system of rewards and consequences Consistency !!

Oppositional defiant disorder (ODD)

is characterized by a persistent pattern of angry mood and defiant behavior that occurs more frequently than is usually observed in individuals of comparable age and developmental level and interferes with social, educational, occupational, or other important areas of functioning It must be understood as distinct, pervasive, and more disruptive than the sometimes negativistic and oppositional behavior that is typical in children and adolescents. often precedes conduct disorder, especially in children with onset of conduct disorder prior to 10 years of age

Separation anxiety disorder

is characterized by excessive fear or anxiety concerning separation from those to whom the individual is attached The anxiety is beyond that which would be expected for the individual's developmental level and interferes with social, academic, occupational, or others areas of functioning. Onset may occur any time before age 18 years but is most commonly diagnosed around age 5 or 6, when the child goes to school Diagnosis at this time may be related to the surfacing of symptoms when the child is faced with new stressors and the recognition of symptoms by school counselors and teachers. Separation anxiety disorder can be a precursor to adult panic disorder

Characteristics of ODD

is characterized by passive-aggressive behaviors such as stubbornness, procrastination, disobedience, carelessness, negativism, testing of limits, resistance to directions, deliberately ignoring the communication of others, and unwillingness to compromise Other symptoms that may be evident are running away, school avoidance, school underachievement, temper tantrums, fighting, and argumentativeness. Initially, the oppositional attitude is directed toward the parents, but in time, relationships with peers and teachers become affected Usually these children do not see themselves as being oppositional but believe the problem is caused by the unreasonable demands of others. These children are often friendless, perceiving human relationships as negative and unsatisfactory. School performance is usually poor because of their refusal to participate and their resistance to external demands.

Tourrette's Disorder

is characterized by the presence of multiple motor tics and one or more vocal tics, which may appear simultaneously or at different periods during the illness The disturbance may cause distress or interfere with social, occupational, or other important areas of functioning.

Classic characteristics of conduct disorder

is the use of physical aggression to violate the rights of others manifests itself in virtually all areas of the child's life (home, school, with peers, and in the community) Stealing, lying, and truancy are common problems The child lacks feelings of guilt or remorse. The use of tobacco, liquor, or nonprescribed drugs, as well as the participation in sexual activities, occurs earlier than at the expected age for the peer group Projection is a common defense mechanism. Low self-esteem poor frustration tolerance, irritability, and frequent temper outbursts. Level of academic achievement may be low in relation to age and IQ. Manifestations associated with ADHD

Environmental factos that are associated with tourrette's?

maternal alcohol use during pregnancy, low birth weight, complications during childbirth, and infection may be associated with the development of Tourette's disorder

Sociocultural factors and ID

may be attributed to deprivation of nurturance and social stimulation and to impoverished environments associated with poor prenatal and perinatal care and inadequate nutrition other mental disorders, such as ASD, can result in intellectual disability.

Characteristics of a child with separation anxiety disorder

may occur as early as preschool age; it rarely begins as late as adolescence the child has difficulty separating from the mother. separation reluctance is directed toward the father, siblings, or other significant individual to whom the child is attached. Anticipation of separation may result in tantrums, crying, screaming, complaints of physical problems, and clinging behaviors. Anticipation of separation may result in tantrums, crying, screaming, complaints of physical problems, and clinging behaviors. During middle childhood or adolescence, they may refuse to sleep away from home (e.g., at a friend's house or at camp) They are generally well liked by their peers and are reasonably socially skilled. Worrying is common and relates to the possibility of harm coming to self or to the attachment figure. Younger children may even have nightmares to this effect

Common side effects for Alpha agonists

palpitations, bradycardia, constipation, dry mouth, and sedation.

Temperament in conduct disorder

refers to personality traits that become evident very early in life and may be present at birth. Children who show signs of an irritable temperament, poor compliance, inattentiveness, and impulsivity as early as age 2 may show signs of conduct disorder at later ages Bernstein adds that children with severe temperamental disturbances, including poor attachment, may develop ODD and conduct disorder despite good parental intervention

Biological influences associated with conduct disorder

researchers attempted to determine the structure of genetic and environmental influences in conduct disorder and found the familial risk to conduct disorder is composed of two discrete dimensions of genetic risk, rule-breaking (such as truancy), and overt aggression (harming other people), and one dimension of shared environmental risk, reflecting covert delinquency (such as stealing and hurting animals)

ASD: Impairment in communication and imaginative activity

severe ASD, language may be totally absent or characterized by immature structure or idiosyncratic utterances whose meaning is clear only to those who are familiar with the child's past experiences Nonverbal communication, such as facial expression or gestures, may be absent or socially inappropriate. are misinterpreted as being deaf The pattern of play is often restricted and repetitive.

Conduct disorder

there is a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated Physical aggression is common, and peer relationships are disturbed A number of comorbidities are common with conduct disorder, including ADHD, mood disorders, learning disorders, and substance use disorders When the disorder begins in childhood, there is more likely to be a history of ODD and a greater likelihood of antisocial personality disorder in adulthood than if the disorder is diagnosed in adolescence