Childhood Disorders

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  1. Nature vs. Nurture?
    Knowing which will steer you towards proper treatment. 
  2. What is Developemental theory?
    • Maps predictable course by identifying stages that occur in linear fashion
    • Tasks must be mastered before child moves to next level
    • The mastery of these tasks gives the child a sense of control over himself and his environment
    • Regression may occur at any time of a maturational achievement
    • Regression may occur during stress
  3. Competency skills (strayhorn)
    • Establishing closeness and trusting relationships……INFANCY
    • Handling separation and independent decision making…..TODDLERHOOD
    • Negotiating joint decisions and interpersonal conflict…..PRESCHOOL
    • Dealing with frustration and unfavorable events…..MIDDLE CHILDHOOD
    • Celebrating good feelings and experiencing pleasure…MIDDLE CHILDHOOD
    • Working with delayed gratification..EARLY A
    • Relaxing and playing….EARLY ADOLESCENCE
    • Cognitive processing through words, symbols and images…..LATER ADOLESCENCE
    • Establishing an adaptive sense of direction and purpose…..LATER ADOLESCENCE
  4. Childhood anxiety?
    • Distress when separated from parent and home
    • School refusal- use of transitional object
    • Pervasive worry and fearfulness
    • Restlessness and irritability
    • Phobias
    • Somatic complaints
    • Restless sleep and nightmares (big one with kids). 
    • Repetitive play of stressful events
  5. Interventions for childhood anxiety?
    • Cognitive behavioral therapy
    • Treat parental anxiety
    • Drug therapy in conjunction with psychotherapy
    • Relaxation and imagery
  6. Childhood depression?
    • Persistent depressed mood, unhappiness  and irritability
    • Loss of interest in friends and play
    • Loss of energy
    • Deterioration in school work
    • Loss of appetite and no weight gain
    • Sleep disturbance
    • Somatic complaints
    • Suicidal ideation, worthlessness
  7. Interventions for childhood depression?
    • Cognitive behavioral therapy
    • Family therapy
    • Antidepressant drug therapy (Prozac)
    • Play therapy
    • Assess and deal with suicidality
  8. Childhood Bipolar disorder?
    • Hyperactive does not start till age of 5 or 6
    • Easily distracted
    • Interrupts others
    • Doesn’t need much sleep or sleeps too much
    • Some same symptoms as adults
    • Treated with mood stabilizers like with adults
  9. Interventions for childhood bipolar disorder?
    • Mood stabilizers
    • Antipsychotics
    • Structure and predictability in the environment
    • Reinforce positive behaviors
    • Use simple clear instructions: One step at a time
    • Use notes and lists to assist memory, back packs
    • Discuss daily expectations : checklist with rewards
    • Set up schedule
  10. What is Attention Deficity Hyperactivity Disorder? (ADHD)
    • Difficulty in attending to details,mistakes
    • Difficulty in tasks/play
    • Not seeming to listen
    • Failure to follow through on instructions
    • Difficulty in organizing
    • Loss of items
    • Distractible and forgetful in daily activities
    • Significant impairment in two or more settings
  11. What are the observable symptoms of ADHD?
    • Fidgeting hands/feet
    • Leaving seat
    • Running around or climbing excessively
    • Difficulty in quiet activities
    • “on the go”,  “driven by a motor”
    • Often talking excessively
    • Blurting, interrupting and difficulty WAITING
  12. Interventions for ADHD?
    • Structure and predictability in the environment
    • Encourage child to slow down
    • Reinforce positive behaviors
    • Use simple clear instructions: One step at a time
    • Use notes and lists to assist memory, back packs
    • Discuss daily expectations: checklist with rewards
    • Set up schedule
    • Medication: Stimulants and nonstimulants
  13. What is Oppositional Defiant Disorder?
    • Recurrent pattern of negativistic, defiant, disobedient and hostile behavior toward AUTHORITY FIGURES
    • Blames others for his mistakes
    • Easily annoyed, angry and resentful
    • Unwilling to compromise, tests limits, often verbally aggressive
    • Not to be confused with "normal" adolescent behavior.
  14. What are interventions for ODD?
    • Provide consistent rules with logical consequences
    • Help child identify anger
    • Find appropriate ways to express anger
    • Teach social skills
    • *Withdraw from social group
    • Role play to get child in touch with others’ feelings
  15. What is Conduct Disorder?
    • Repetitive and persistent pattern of behavior where child violates the basic rights of others or major social norms or rules.
    • Antisocial behavior:physical violence against others, steals, fire setting, cruelty to animals, bullies others, threatens others, forced sexual behavior, vandalism and truancy, runaway
    • After adolescence, this behavior may fall into antisocial personality disorder.
  16. What are interventions for Conduct Disorder?
    • Provide Limits
    • Help child accept responsibility for his behavior
    • Consistent rules,expectations and consequences
    • Deescalate aggressive episodes
    • Major tranquilizers may be used to manage aggressive behavior
  17. Symptoms of childhood PTSD?
    • Traumatic event(s)
    • Symptoms: increased arousal, anxiety, hypervigilance, irritability, physiological hyperactivity, impulsivity, sleep disturbance (somewhat similar to adults)
    • Intensity of symptoms: trauma, threat to body integrity, sense of security and family system
    • Trauma induced brain response
  18. Interventions for childhood PTSD?
    • Cognitive behavioral therapy
    • Treat parental anxiety
    • Drug therapy in conjunction with psychotherapy
    • Relaxation and imagery
    • Be careful about retelling and re-traumatizing
    • Work with educated therapists
  19. Tools for parents with difficult children?
    • Respond warmly to positive behaviors and ignore negative behaviors when possible
    • Avoid yelling and commanding 
    • Use of time out for negative behaviors
    • Establish reasonable expectations
    • Communicate often in the child’s language
  20. Key protective factors of resilient children
    • Optimistic style
    • Good sense of humor
    • Strong social skills
    • Cognitive competence
    • Good  natured temperament
    • Perseverance
    • Involvement in creative activities
    • Strong problem solving skills
    • Good management of emotions
    • Sense of self awareness

    • Caring and supportive parents
    • Strong parent-child relationships
    • Low levels of family conflict
    • Optimistic parenting styles
  21. ADHD medications?
    Three categories of medications: stimulants, nonstims, and combos. 

    • Ritalin/Methylphenidate (Stimulant)
    • Dexidrine/dextroamphetamine (Stimulant)
    • Combination medications
    • Nonstimulants

    Also review the medication handout posted 
  22. How does Ritalin/Methylphenidate work?
    • Mechanism:
    • Affects norepinephrine & dopamine
    • Stimulates the control centers of the brain 

    Side effects:  nervousness, insomnia, tachycardia, hypertension, arrhythmias, weight loss, etc

    • Nursing implications: 
    • --Teach patient/family not to use caffeine
    • --Monitor weight
    • --Take in the morning to not interfere with sleep
    • --Can stop medication without tapering
  23. How does Dexidrine/dextroamphetamine work?
    • Mechanism:
    • Affects norepinephrine and dopamine
    • Stimulates the control centers of the brain

    Side effects:  restlessness, insomnia, weight loss, overstimulation, tachycardia, hypertension, arrhythmias, tremor, weight loss, etc

    • Nursing Implications: 
    • --Teach patient/family not to use caffeine
    • --Take in the morning to not interfere with sleep
    • --Monitor weight
    • --Can stop medication without tapering
  24. What is Adderall combo Rx?
    Amphetamine: dextramphetamine saccharate with dextroamphetamine sulfate

    Similar actions, side effects and nursing implications to dexidrine/dextroamphetamine
  25. How does Strattera/Atomoxetine?
    Mechanism:  Norepinephrine re-uptake inhibitor (SNRI)

    Side effects:  Headache, insomnia, decreased appetite, abdominal pain, constipation, dry mouth, cough, increased sweating, dermatitis

    Nursing implications: 

    • Monitor growth of child
    • --Can stunt growth
    • --If weight unsatisfactory, consider changing medication
    • --Monitor blood pressure and pulse
    • --Can stop medication without tapering
Card Set:
Childhood Disorders
2013-02-05 05:22:15

Mental Health
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