Sherpath: Developmental Disability

The nurse is conducting an assessment of a school-aged child who has autism spectrum disorder (ASD). What should the nurse do to best assess the child's functional abilities?

--Ask the child "Can you tell me about your morning routine?" This question will allow the child to use verbalization skills as well as explain the routine that is preferred. --Observe the child while the child is performing activities of daily living (ADLs) to see what assistance is needed. The nurse needs to observe the child while he or she is performing ADLs to determine whether the child has age-appropriate developmental abilities. These observations will help determine what assistance the child needs.

A parent asks the nurse how her child contracted autism spectrum disorder (ASD). Which is the nurse's best response?

"ASD has many different proposed causes, so pinpointing the exact cause is likely impossible." This is a correct statement that gives the parent accurate information; therefore, this is the nurse's best response.

A parent tells the nurse, "My daughter has been diagnosed with autism spectrum disorder (ASD), but she does not act anything like my niece who also has ASD. I don't understand how they can behave so differently." How should the nurse respond?

"ASD is a spectrum of disorders with a wide range of manifestations and severity. Each child is unique, and no two children have the exact same symptoms." The nurse should explain that children will behave differently because ASD is a spectrum of disorders with different levels of severity. Symptoms vary greatly.

The parent of a child with autism spectrum disorder (ASD) states, "I knew that I should not have allowed her to get her vaccinations. If I had listened to my sister, this never would have happened." How can the nurse appropriately respond to this statement?

"Although many people think that vaccinations are linked to ASD, the research has not shown that there is a correlation between the development of ASD and receiving vaccines." The research does not show a correlation between ASD and vaccinations, so this is a true statement. The research that originally indicated this association was later determined to be fraudulant.

The student nurse states, "My sister was so worried that her baby might be born with an intellectual disability. She was born healthy. I am so excited that intellectual disability is not even possible anymore." How should the nurse respond to this statement?

"Childhood conditions and environmental problems can cause intellectual disability. Let's talk about ways to prevent these from causing intellectual disability." The nurse needs to clarify that intellectual disability can still be diagnosed after birth and that there are ways to help prevent diseases and environmental problems from affecting children.

The nurse is assessing a 3-year-old child for an intellectual disability. What questions should the nurse ask the parent(s)?

"Does your child have a seizure disorder?" Seizure disorders often develop in children with intellectual disability, so the presence of a seizure disorder could indicate the presence of an intellectual disability along with other signs and symptoms. "Can your child understand simple directions?" A child with intellectual disability does not have age-appropriate cognitive skills. A 3-year-old child should be able to follow a simple direction, so the inability to do so indicates a potential problem. "Is your child developing as you would expect?" This question allows the parents to bring up any concerns about the child's development, which will help the nurse gather information. "Is your child able to verbally communicate needs?" Communication is a developmental milestone that is often delayed in a child with an intellectual disability.

Parents come to the clinic with their infant who was recently diagnosed with autism spectrum disorder (ASD). The parents state that they think their child is "just fine." What questions can the nurse ask to assess for signs of ASD?

"Does your infant look at you when you speak to him or her?" The child with ASD may not show interest in the parents and may not show the early signs of communication expected. "Does your infant seem to do the same actions over and over again with toys?" Children with ASD may not play with toys in a way that is expected; they may engage in repetitive actions with toys instead. "Has your child shown behaviors that indicate that he or she misses you when you are gone?" Children with ASD may not show signs of attachment to the caregiver and therefore the nurse should ask this type of question. "If your child appears distressed, does he or she come to you and climb on your lap and look for comfort?" Children with ASD often do not look for comfort or soothing from their parents.

A parent of two children, including a girl with an intellectual disability states, "I have a hard time working with my daughter. She just doesn't seem to understand what I'm saying like my son does." What information can the nurse provide to help the parent?

"Let's talk about how to use simple, concrete explanations and incorporate play while you are teaching her something new." A child with intellectual disability will do best with simple, concrete, solution-focused information and will learn best through therapeutic play and demonstrations. The nurse should provide this information to the parent to promote effective communication.

An adolescent with moderate intellectual disability states, "I want to live on my own when I become an adult." What is the nurse's best response?

"Let's talk about how we can work together to prepare you for more independence." Supervision and support that can be provided in a group home is a viable option for someone with moderate intellectual disability.

A 2-year-old child has just been diagnosed with autism spectrum disorder (ASD). The parents want to know whether their child has a serious case because it was diagnosed so early. How should the nurse respond?

"The early diagnosis of ASD means that your child will have a milder form of ASD." The timing of the diagnosis of the disorder is not directly related to the severity of the illness. "Recognizing that your child has ASD at an early age means that the child will need more interventions to ensure normal development." The child does not necessarily need more interventions because the diagnosis was made early. Also, early intervention does not guarantee normal development. "Recognizing and treating ASD early does not determine the severity of the disorder, but it increases the chance that your child will maximize his or her potential." The earlier the interventions and treatments can start, the better the prognosis for functional ability will be for the child.

The nurse is caring for an adolescent with a moderate intellectual disability. How should the nurse best communicate with the adolescent?

"The floors get very slippery when they are wet, so if you spill or get water on the floor, just let me know, and we can get it cleaned up, so you don't fall." The nurse should provide safety- and solution-focused information that is simple and concrete.

The parent of a child with intellectual disability states, "I thought she would be doing more by now. They said her condition is only mild. I think she is just difficult on purpose and doesn't try." What should be the nurse's priority assessment question?

"What are your expectations for your child?" The nurse should determine whether the expectations that the parent has are realistic and appropriate for the functional level of a child with mild intellectual disability.

The mother of a newborn with fetal alcohol spectrum disorder (FASD) appears withdrawn and depressed. The mother does not often hold or look at the infant. When she does hold the newborn, she becomes tearful. Which would be appropriate comments for the nurse to make?

"You appear upset when you hold your baby. How are you feeling?" The nurse should point out what is observed and encourage the mother to voice feelings about the infant's condition.

The mother of young child with fetal alcohol spectrum disorder (FASD) asks, "What does this disorder mean for my plan to have a big family?" What would be the most therapeutic response?

"You can have more children. Let's discuss pregnancy planning and alcohol avoidance in order to prevent having another child with FASD." Having one child with FASD does not mean that the mother cannot have more children, but it does mean that the mother should receive education to decrease the likelihood that she will drink during future pregnancies.

A mother of two is adopting an infant with fetal alcohol spectrum disorder (FASD). She asks the nurse. "What can I expect my baby to be like?" What education is important for the nurse to share?

"Your new infant may be more irritable than the average infant." The nurse needs to share information that will help the new mom prepare for difficulties that might be encountered with an infant with FASD. "The new baby is more likely to have a smaller head than the average infant." Microcephaly is common in FASD. "The infant may be smaller and grow at a slower rate than your other children did." The nurse should mention that the child may have a growth deficiency.

The parents of a preschooler with intellectual disability are in the health care provider's office. The parents seem anxious, disheveled, and tired. What can the nurse do to be most effective when working with this family?

--Bring up the aspects of caring for the preschooler that the parents are doing well. Positive reinforcement for the parents can help increase their self-confidence and also shows that the nurse is listening, which can help facilitate a therapeutic relationship. --Provide information about local support groups for parents of children with disabilities. The parents may not choose to attend meetings of the support group, but the nurse should recognize that the parents might benefit from additional community resources and should provide this information. --Ask the parents about their ability to maintain other roles, such as that of an employee or a significant other. Assessing how the parents are doing in their other roles helps the nurse to gather information about coping and recognizes the parents as individuals, as well as caregivers.

The nurse is treating a newborn and the mother confides in the nurse that she drank alcohol socially throughout the pregnancy. The nurse should be careful to assess for which specific signs and symptoms?

--Hypotonia Hypotonia is correlated with FASD, which can result from maternal alcohol ingestion during pregnancy. --Weak suck with bottle feeds Feeding problems are common in an infant with FASD, which can occur as a result of maternal alcohol ingestion during pregnancy. --Head circumference below target for age Microcephaly is a common manifestation of FASD. --Incessant crying despite soothing attempts Difficulty in soothing the infant could be an indication of FASD, which correlates with the mother's history of alcohol ingestion throughout pregnancy.

The nurse is caring for a child with autism spectrum disorder (ASD). What should the nurse do to best assist the child's tolerance of the hospitalization?

--Regularly assess for any changes in the child's behavior, such as withdrawal or self-injury. The nurse should monitor for symptoms that can indicate anxiety and a lack of comfort to determine how the child is adapting to the hospitalization. Correct --Provide the child with her favorite stuffed animal each time that she needs to recognize that it is time to get ready for bed. Many children with ASD will require specific cues to remain oriented. Providing a familiar object will keep the child from being overly stressed by the changes related to hospitalization. --Speak with the parents about the usual routines the child prefers for getting ready for the day ahead in the morning and going to bed at night. If the nurse knows the routines that the child usually follows, the nurse can follow the same routines, which will minimize the stress that the child experiences during hospitalization.

The nurse is assessing an infant with fetal alcohol spectrum disorder (FASD). The nurse performs a thorough head-to-toe assessment. What is the primary reason for this assessment?

A thorough assessment is completed because other abnormalities are often present in an infant with FASD. The nurse does need to determine whether any other associated congenital conditions are present so that a plan of care can be designed.

A nursing student asks the instructor, "How can I tell whether someone has autism spectrum disorder (ASD) or intellectual disability?" How should the instructor respond?

Children with intellectual disability usually imitate others, but children with ASD lack imitative skills. A child with ASD often has abnormal communication and lacks imitative skills, while a child with intellectual disability may have limited language but be able to imitate others and use gestures.

While assessing an infant with fetal alcohol spectrum disorder (FASD), the nurse does not see many of the characteristics that she expected to see. What is the explanation for this finding?

FASD is a spectrum of disorders, so a variety of signs and symptoms is possible. Children will not all present the same way. Some children will have mild forms, and others will have more severe forms of the disorder.

A child is brought to the clinic with suspected fetal alcohol spectrum disorder (FASD). What action taken by the nurse will be a priority in caring for this patient and the family?

Prepare the family for the necessity of a workup to determine the symptoms and other conditions associated with the disorder. An extensive workup is needed when a child is suspected of having FASD. The parents need to be prepared for the assessments and testing that will be required to confirm or rule out the diagnosis.

A school nurse is providing education to a group of teachers regarding working with intellectually disabled school-aged children. What information is most important for the nurse to emphasize?

Put a stop sign picture on any object or area that you do not want the children to touch or enter. Safety is the most important information. Frequent visual reminders should be provided for children with intellectual disability.

The parents of a child with a neurologic disorder and severe intellectual disability are concerned about the child's frequent emotional changes and anger. How might the nurse interpret these changes in emotion?

The child may be frustrated and unable to appropriately express needs. Children with severe intellectual disability have limited expressive speech and limited self-help skills.

A 10-year-old patient with a history of fetal alcohol spectrum disorder (FASD) without any identifiable intellectual or physical impairments comes into the clinic with the parents. The parents want to know what impairments might be expected as their child continues to grow. What information should the nurse share with this family?

The child may start to experience joint pain or stiffness. Joint abnormalities are common manifestations in a child with FASD.

The nurse received report about a child experiencing early signs of difficulties associated with mild intellectual disability. What behaviors should the nurse anticipate from the child?

The child spends time alone and rarely makes eye contact. Isolation and signs of low self-esteem are behaviors associated with mild intellectual disability.

A nurse is working for the first time with a 17-year-old diagnosed with autism spectrum disorder (ASD). The adolescent seems very attached to a sibling. The parents encourage the 15-year-old sibling to spend the night in the hospital. Allowing a sibling to spend the night is against the policy of the hospital unit. Which is the nurse's best response?

The nurse should discuss the policy with the parents of the patient and develop a plan that meets the requirements of the facility and the needs of the adolescent. The nurse needs to create a plan to help ensure the safety and comfort of the adolescent patient with ASD. Children and adolescents with ASD often need someone, in this case, the sibling, to help ensure their safety. The nurse can work with the parents to safely and correctly accomplish this.

The nurse is trying to feed a newborn with fetal alcohol spectrum disorder (FASD). The nurse is holding the baby in different positions to promote feeding, but the newborn is still spitting up the formula. What should be the nurse's next action?

The nurse should try only feeding the infant small quantities at a time. Decreasing the amount of each feeding can help the infant with FASD tolerate more food, which is important.