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Childhood disorders
- 1. Presentation onPresentation on childhooddisorderschildhood disorders Presented by : Parul Prasher mental health nursing dept
- 2. Disorders Usually 1DisordersUsually 1stst DiagnosedDiagnosed in Infancy, Childhood, &in Infancy, Childhood, & AdolescenceAdolescence Core Concept Of Diagnostic Group: Categorized by time of onset Predominantly disorders of abnormal development and maturation. Emphasis of disorders is on the inability of the individual to attain certain normal developmental milestones and the associated functions, capabilities, & behaviors.
- 3. 10 DIAGNOSTIC SUBGROUPS10DIAGNOSTIC SUBGROUPS (DSM-IV-TR)(DSM-IV-TR) 1) Mental Retardation 2) Learning Disorders 3) Motor Skills Disorders 4) Communication Disorders 5) Pervasive Developmental Disorders 6) Attention Deficitand Disruptive Behavior Disorders 7) Feeding & Eating Disorders ofInfancy & Early Childhood 8) Tic Disorders 9) Elimination Disorders 10) Other Disorders ofInfancy, Childhood, or Adolescence
- 5. Mental RetardationMental Retardation Characteristics: IQis significantly below average (< 70) Accompanied by deficits in adaptive functioning, e.g. communication, self-care, home living, social/interpersonal skills, use of community resources, self-direction, academic skills, work, leisure, health, safety.
- 6. Onset and codingOnsetand coding Onset before age 18 years Coding: coded on axis II Code based on degree of severity, reflecting level of intellectual impairment: ◦ Mild Mental Retardation – IQ from 50-55 to 70 ◦ Moderate Mental Retardation – IQ from 35-40 to 50-55 ◦ Severe Mental Retardation – IQ from 20- 25 to 35-40 ◦ Profound Mental Retardation – IQ below 20-25
- 7. Mental RetardationMental Retardation Prevalence: 1-3% of population; 90% are mild MR Course: chronic Prognosis: variable, depending on IQ & level of impairment Gender differences: more prevalent for males (1.6 to 1); no gender differences for severe & profound MR Causes: genetic; chromosomal (Down syndrome, Fragile X syndrome, Lesch-Nyhan syndrome); environmental (deprivation, abuse, neglect); prenatal (exposure to disease, alcohol, drugs, chemicals, poor maternal nutrition); perinatal (difficulties during labor & delivery); postnatal (malnutrition, infections, & head injuries) Treatment: behavioral skills training; communication training; supported living and employment; mainstreaming
- 8. Causes and TreatmentCausesand Treatment Causes: genetic; chromosomal (Down syndrome, Fragile X syndrome, Lesch- Nyhan syndrome); environmental (deprivation, abuse, neglect); prenatal (exposure to disease, alcohol, drugs, chemicals, poor maternal nutrition); perinatal (difficulties during labor & delivery); postnatal (malnutrition, infections, & head injuries) Treatment: behavioral skills training; communication training; supported living and employment; mainstreaming
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- 11. Characteristics: Inadequate development ofspecific academic skills, such as reading, writing, and math. Specific academic skills are substantially below expected for age, intelligence, and education Significantly interferes with aspects of life requiring those skills. Subtypes: Reading Disorder Mathematics Disorder Disorder of Written Expression Learning Disorder Not Otherwise Specified
- 12. Prevalence: ◦ general population:5-10% ◦ reading disorders: 5-15% ◦ math disorders: 6% Racial: more common in black children Negative outcomes: negative school experiences; school drop-out; lower employment rates; lower educational & career goals Causes: genetics; structural & functional differences in the brain Treatment: educational interventions (processing skills; cognitive skills; behavioral skills)
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- 14. Tic Disorder: Tourette’sTicDisorder: Tourette’s DisorderDisorder Symptoms: characterized by multiple motor tics and one or more vocal tics (involuntary, sudden, rapid, nonrhythmic, stereotyped motor movements or vocalizations), which occur many times a day, nearly every day, or intermittently for more than a year. Common motor tics: eye-blinking, eye-rolling, spitting, flipping/twirling hair, rolling head around, bending/jumping, skin picking, shrugging/jerking shoulders, thrusting pelvic movements, tapping fingers/feet Common vocal tics: throat clearing, tongue-clicking, whistling, grunting, humming, hoots, howls, burps/belches, animal noises, repetition of one’s own words, repetition of others’ words
- 15. Contd .Contd . Causes: genetic (32% have relatives with TD); abnormal metabolism of 5HT & D; brain processing problem (basal ganglia) Prevalence: decreases with age; 5-30 per 10,000 in childhood; 1-2 per 10,000 in adulthood Gender: 2-5x as common for males Onset: as early as 2 yrs; average age of onset is 6-7 yrs; typically develops by age 14 Course: severity, frequency, and disruptiveness of sx diminish during adolescence & adulthood Treatment: antipsychotics; antihypertensive medications; SSRI’s; self-monitoring; relaxation training; habit reversal
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- 17. Attention Deficit/Hyperactivity DisorderAttentionDeficit/Hyperactivity Disorder Includes two major syndromes: 1) Inattention 2) Hyperactivity-Impulsivity Syndromes may occur independently or together, but usually some components of each are present. Symptoms begin before age 7 Symptoms cause some impairment in 2 or more settings.
- 18. Inattention: 6+ ofthe following for 6+ months Often fails to give close attention to details Often makes careless mistakes in school, work, etc. Often has difficulty sustaining attention Often doesn’t seem to listen when spoken to directly Often doesn’t follow instructions Often fails to finish schoolwork, chores, or work duties Has difficulty organizing tasks & activities Avoids or dislikes tasks requiring sustained mental effort Often loses things Is easily distracted by extraneous stimuli Is forgetful in daily activities
- 19. Attention Deficit/Hyperactivity DisorderAttentionDeficit/Hyperactivity Disorder Hyperactivity-Impulsivity 6+ of following for 6+ months Hyperactivity: Fidgets with hands or feet; squirms in seat Difficulty staying in seat Excessive running, climbing, or restlessness Difficulty playing or engaging in leisure activities quietly Often “on the go;” acts as if “driven by a motor” Often talks excessively Impulsivity: Often blurts out statements Impatient; difficulty awaiting turn Often interrupts or intrudes on others
- 20. Attention Deficit/Hyperactivity DisorderAttentionDeficit/Hyperactivity Disorder Subtypes: ◦ AD/HD, Predominantly Inattentive Type ◦ AD/HD, Predominantly Hyperactive-Impulsive Type ◦ AD/HD, Combined Type ◦ AD/HD, Not Otherwise Specified Onset: 3-4 years old Age: 68% have ongoing sx in adulthood; inattentive subtype is more common in adolescents and adults Gender: ratios of males to females range from 2:1 to 9:1; Combined and Hyperactive Subtypes are much more common in males than females Prevalence: up to 3-7% of school-age children
- 21. ADHD: Associated FeaturesADHD:Associated Features Academic deficits School-related problems Peer rejection Low frustration tolerance Tantrums Poor self-esteem Mood swings Bossiness Stubbornness Accidents Driving difficulties – speeding, accidents
- 22. ADHD: Diagnostic ConsiderationsADHD:Diagnostic Considerations Difficulty of distinguishing normal activity from hyperactivity and normal distractibility from attention deficit distractibility. Need to evaluate behavior in terms of what’s normal for others of same gender, age, developmental level, cultural background. Behaviors must occur in multiple settings. Behaviors must cause clinically significant impairment. Symptoms must have been present and caused impairment by age 7. Combined and Hyperactive Subtypes are less likely to be missed.
- 23. ADHD: Contributing FactorsADHD:Contributing Factors Genetics: increased incidence of ADHD & psychopathology in families & relatives Prenatal factors: inadequate oxygen; drug exposure; maternal smoking Neurotransmitters: inadequate availability of dopamine; NE, 5HT, GABA also implicated Brain abnormalities: frontal cortex, basal ganglia, & cerebellar vermis are smaller Exposure to toxins: allergens, food additives Parenting: negative attempts to control their behavior; intrusive, over-bearing parenting
- 24. Attention Deficit/Hyperactivity DisorderAttentionDeficit/Hyperactivity Disorder Treatments: Medication – stimulants, Strattera (SNRI), Wellbutrin Psychoeducation & bibliotherapy Skills-based training – time management, organizational skills, study skills, problem- solving, social skills
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- 27. Conduct DisorderConduct Disorder Repetitive, persistent pattern of behavior in which the basic rights of others or major societal norms or rules are violated. 3 or more of the following are present in the past 12 months, and at least one of the following is present in the past 6 months. 1) Aggression to people and animals 2) Destruction of property 3) Deceitfulness or theft 4) Serious violations of rules
- 28. Conduct DisorderConduct Disorder 1)Aggression to People and Animals: ◦ Bullying, threats, intimidation ◦ Physical fights ◦ Use of weapons ◦ Physical cruelty to people ◦ Physical cruelty to animals ◦ Mugging, purse snatching, extortion, armed robbery ◦ Forced sexual activity
- 29. Conduct DisorderConduct Disorder 2)Destruction of Property: ◦ Deliberate fire-setting ◦ Deliberate destruction of others’ property 3) Deceitfulness or Theft ◦ Breaking & entering ◦ Lying; conning ◦ Stealing; shoplifting; forgery 4) Serious Violations of Rules ◦ Breaking curfew prior to age 13 ◦ School truancy prior to age 13 ◦ Running away from home
- 30. Conduct DisorderConduct Disorder Subtypes: Conduct Disorder, Childhood Onset – onset of at least 1 criterion prior to age 10 Conduct Disorder, Adolescent Onset – absence of any criteria prior to 10 Conduct Disorder, Unspecified Onset – age of onset is unknown Specifiers: Mild – few, if any, conduct problems in excess of those required to make dx; cause only minor harm to others Moderate – number of conduct problems and effect on others are in the intermediate range Severe – many conduct problems in excess of those required to make dx; cause considerable harm to others
- 31. Conduct DisorderConduct Disorder Etiology: genetics; decreased arousal; low levels of 5HT; neurological deficits Prevalence: 2-9% of nonclinical population; up to 1/3- 1/2 of child mental health referrals; 87-91% of incarcerated juveniles Gender Differences: mostly males Onset: as early as preschool Prognosis: poor; 2/3rds of cases develop into Antisocial Personality Disorder Treatment: parent management training; community- based interventions (group homes, wilderness programs; therapeutic boarding schools); CBT (social skills, problem solving, cognitive restructuring)
- 33. Oppositional Defiant DisorderOppositionalDefiant Disorder Pattern of negativistic, hostile, and defiant behavior for at least 6 months. At least 4 of the following are present: ◦ Often loses temper ◦ Often argues with adults ◦ Often actively defies or refuses to comply with adults’ requests or rules ◦ Often deliberately annoys others ◦ Often blames others for own mistakes or misbehavior ◦ Is often touchy or easily annoyed by others ◦ Is often angry or resentful ◦ Is often spiteful or vindictive
- 34. Oppositional Defiant DisorderOppositionalDefiant Disorder Prevalence: 1-6% Gender differences: more prevalent for males prior to puberty; ratio evens out after puberty Prognosis: relatively persistent – some of the behaviors persist into adulthood, others are outgrown; higher divorce rate, employment difficulties, and drug/alcohol abuse for those with ODD Causes: marital conflict; family discord; inconsistent parenting; overly lenient or rigid parent; coercive or aversive parent-child interactions; genetics Treatment: parent training; family therapy; behavioral therapy (anger management, social skills training, problem solving, frustration tolerance); cognitive interventions to reduce negativity
- 38. Separation Anxiety DisorderSeparationAnxiety Disorder At least 4 weeks of inappropriate or excessive anxiety about separation from home or major attachment figures, as evidenced by at least 3 of the following: ◦ excessive anxiety regarding separation ◦ excessive fears of losing major attachment figures ◦ nightmares involving the theme of separation ◦ refusal to go to school ◦ refusal to be alone or without major attachment figures ◦ refusal to sleep away from home or attachment figures ◦ repeated physical complaints when separation occurs or is anticipated Onset prior to age 18
- 39. Pervasive DevelopmentalPervasive Developmental DisordersDisorders Characterizedby: A broad-based impairment or a loss of functions expected for child’s age. Includes 3 components: 1) Impairment in social interactions/relationships 2) Impairment in communication/language 3) Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities
- 41. Autistic DisorderAutistic Disorder Abnormal functioning in at least one of the following areas, with onset prior to 3: 1) Social interaction 2) Language and communication 3) Symbolic, imaginative play Qualitative impairment in social interaction and relationship development Qualitative impairment in communication, language, and conversation skills Restricted, repetitive, stereotyped patterns of behavior, interests, activities.
- 42. AutismAutism Mental retardation:75-80%; 50% are profoundly or severely MR; 25% are moderately MR; 25% borderline to average IQ Gender differences: higher IQ – more prevalent among males; IQ < 35 – more prevalent among females Prevalence: 1 in 500 births Onset: first apparent in infancy & toddlerhood Course: chronic; life-long impairment; 50% never acquire speech Causes: abnormalities in brain structure and function (5HT synthesis, cerebellum); genetics Treatments: intensive behavioral Tx focusing on improving communication, social and daily living skills and reducing problem behaviors; early intervention programs; applied behavior analysis; parent training; mainstreaming for education; community interventions (supportive living arrangements & work settings)
- 45. Asperger’s DisorderAsperger’s Disorder Qualitativeimpairment in social interaction and relationship development Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities But lack any clinically significant delay in language or cognitive development
- 46. Asperger’s SyndromeAsperger’s Syndrome Whatyou see: Anxious, excessive desire for sameness Preoccupation with stereotyped, repetitive activities Obsess about objects Limited interests Can’t relate to others Can’t read emotions Can’t understand social cues Social isolation, socially inept Average IQ scores Motor clumsiness Poor coordination
- 47. Asperger’s SyndromeAsperger’s Syndrome Gender:up to 4x as common for males Prevalence: up to 5x as common as Autism Onset: later onset than Autism Course: chronic, life-long Etiology: genetics; brain abnormalities (limbic system, 5HT & D systems, right hemisphere)
- 48. Asperger’s Syndrome: TreatmentsAsperger’sSyndrome: Treatments Behavioral treatments/skills building: interventions targeting problem behaviors, problem solving, social skills, communication skills, empathy-building, daily living skills School-based interventions: mainstreaming; tutoring; special aides; multiple modalities for presenting information Psychotherapy to address accompanying psychiatric disorders, such as depression and anxiety Medications: antidepressants, antipsychotics
- 50. Nurses Role InManagement OfNurses Role In Management Of Childhood DisorderChildhood Disorder
- 51. Ensuring thechild’s safety and that of others Stop unsafe behavior. Provide close supervision Give clear directions about acceptable and unacceptable behavior. Improved role performance Give positive feedback for meeting expectations. Manage the environment (e.g., provide a quiet place free of distractions for task completion). Simplifying instructions/directions Get child’s full attention.
- 52. Contd.Contd. Break complex tasksinto small steps. Allow breaks. Structured daily routine Establish a daily schedule. Minimize changes. Client/family education and support Listen to parent’s feelings and frustrations. Improving role performance Simplifying instructions Promoting a structured daily routine Providing client and family education and support