childhood impulse control

Question 1

disorders - Look for behavioral manifestations that

Answer 1

are not age appropriate
deviate from cultural norms in an UNHEALTHY way
Always involve families in the assessment and treatment as well.

Question 2

Intellectual Development Disorders (IDD)

Answer 2

IQ < 70 w/ resulting impairment in function; age of onset < 18 yo

Question 3

mild IDD - and what level of reading and writing

Answer 3

IQ 50-70 (85% of all persons w/ MR) - usually pretty high functioning, most need a little support, can live on their own sometimes. maximum expectation is reading and writing at 6th grade level

Question 4

moderate IDD - expected reading and writing level

Answer 4

IQ 35-50 - maximum expectation is reading and writing at 2nd grade level

Question 5

severe IDD - IQ - and what about speech?

Answer 5

IQ 20-35 - lives in a group home, limited speech.3-4% of ppl with DD.

Question 6

profound IDD

Answer 6

: IQ < 20 - usually secondary to neurological disorder, like cerebral palsy. total care.

Question 7

IDD - causes

Answer 7

genetic, medical and/or environmental factors, birth injuries - cord wrapped around neck, lead poisoning, mold, mercury

Question 8

IDD - comorbities

Answer 8

Common comorbid dxs: ADHD, Mood D/O, ASD (autism spectrum disorder), Szs, Motor pxs

Question 9

tx for IDD - what type of therapy (think of children)

Answer 9

Assess strengths to encourage independence
Use behavior modification
Referrals to community resources (e.g. JPC = Pomeroy center)

Question 10

Autism Spectrum Disorder (ASD) - what age?

Answer 10

sxs usually appear early (as an infant) usually diagnosed between 1 1/2 and 3 yrs old. can appear as early as 6-8 weeks old - eye movements
multiple theories on etiology of ASD

Question 11

autism now affects

Answer 11

1 in every 36 children in the US (1 in 23 boys) and the incidence is growing (in 2000, the rate was 1 in every 150 kids). The older a man is, the more likely the child will be autistic.

Question 12

autism - developmental deficits in social skills and language***

Answer 12

difficulty reading other peoples’ faces
sing song voice, movie quotes over and over again
poor non-verbal and verbal communication

Question 13

autism - over half

Answer 13

have some degree of IDD (IQ<70)

Question 14

autism - males vs. females

Answer 14

males 4X> than females, but females have historically been underdiagnosed

Question 15

autism interventions - what is the therapy called? (aba teaches autism)

Answer 15

early intevention is crucial. Applied Behavior Analysis (ABA)– behavioral therapy to teach communication skills, improve social interaction - give a star or sticker if they respond appropriately.

Question 16

autism - diet

Answer 16

diet and complementary therapies are controversial; mixed results - inflammatory foods. corn, gluten, soy. might result in symptom reduction, but not cure. autism have higher heavy metals in system - so chelation may be used but can be very dangerous.

Question 17

regressive autism

Answer 17

at 1 or 2, they stop functioning suddenly. these kids usually respond to alternative interventions.

Question 18

meds for autism (zach is crazy)

Answer 18

no cure available, but Abilify and Risperdal have been FDA-approved for tx of tantrums, aggression, SIB; SSRIs for depression and anxiety sxs

Question 19

autism prognosis

Answer 19

generally poor prognosis (better w/ higher IQ/language skills)

Question 20

Attention Deficit Hyperactivity Disorder (ADHD)

Answer 20

characterized by poor attention span, distractibility, hyperactivity and impulsivity. the daydreamer, not absorbing material, disorganized, careless mistakes on homework. they can hyper focus on something they’re really interested in though.

Question 21

ADHD - hyperactive symptoms - sleep?

Answer 21

interrupting, risk for injury nanda, ppl w/ adhd usually sleep well.

Question 22

ADHD - causes - what about birth weight

Answer 22

genetics, brain injury, lead exposure, alcohol and tobacco use during pregnancy, low birth weight, premature delivery

Question 23

autism - boys vs. girls

Answer 23

males 4X> than females, but females have historically been underdiagnosed

Question 24

ADHD meds (Dex has ADHD)

Answer 24

ppl w/ ADHD are dopamine seeking*
CNS stimulants e.g. Ritalin (methylphenidate**), Dexedrine, Adderall

Question 25

ADHD meds cont

Answer 25

atomoxetine (Strattera) - a norepinephrine reuptake inhibitor: less chance for abuse

Question 26

ADHD meds cont (antidepressants)

Answer 26

Antidepressants e.g. SSRIs, buproprion (increases dopamine and norepinephrine)

Question 27

ADHD meds cont

Answer 27

Alpha agonists e.g. clonidine and guanfacine (for aggression, impulsivity, hyperactivity)

Question 28

nursing action - ADHD

Answer 28

Establish clear limits, regular routine - they need external structure Decrease stimuli (2/2 difficulty “filtering out” extraneous stimuli) OR use of music can help some kids focus Behavior modification Protect from injury (2/2 impulsivity, risk-taking bx)

Question 29

Oppositional Defiant Disorder (ODD)

Answer 29

just a difficult kid. can develop into conduct disorder. low serotonin.

Question 30

ODD characteristics

Answer 30

disobedience, argumentativeness, angry outbursts, poor frustration tolerance, tendency to blame others rather than take responsibility for actions

Question 31

ODD - high comorbidity w/

Answer 31

ADHD, learning disabilities, mood d/os and PSA

Question 32

ODD - risk factors (odd was neglected)

Answer 32

harsh, inconsistent or neglectful parenting parental conflict, divorce parents w/ PSA, Mood d/o; Personality d/o early institutional living (e.g. group home) need structure, limits

Question 33

Conduct Disorder (CD) - what neurotransmitter is low?

Answer 33

low serotonin

Question 34

CD - characteristics (conduct your substance abuse)

Answer 34

serious violation of societal norms (e.g. aggression towards people and/or animals, destruction of property) fires. substance use, prostitution.

Question 35

CD- most frequently diagnosed d/o among

Answer 35

most frequently diagnosed d/o among child/adolescent inpatient psych units similar to ODD, but more dangerous main difference is clear lack of empathy or remorse (precursor to Antisocial Personality D/O)

Question 36

CD - interventions (also ODD) - and what type of groups are good?

Answer 36

protect others from client’s aggression (intervene prophylactically!) teach/role-model social skills, anger mgmt tx comorbid disorders (e.g. referrals for learning disabilities) assist client to take responsibility for his/her behavior – peer confrontation groups are helpful birth control, STD screen/tx, drug tests prn

Question 37

Intermittent Explosive Disorder (IED)

Answer 37

don’t need to know much about this impulsive, emotional outbursts and aggressive/violent behavior, but different from CD because these kids feel remorseful afterward

Question 38

Separation Anxiety Disorder

Answer 38

inappropriate and excessive anxiety about being away from home or primary attachment figure (often leads to school phobia)

Question 39

Reactive Attachment Disorder of Infancy and Early Childhood - 2 types (react to abuse)

Answer 39

result of gross pathologic care, repeated caregiver changes, abuse, neglect, incest. two types: inhibited (they can’t get close to anyone) and disinhibited (they love everyone)

Question 40

Tourette’s Disorder (a motor disorder

Answer 40

strong genetic component; males 2X > females motor and vocal tics (e.g. blinking, coprolalia (curse words) (<10%), squatting) vocal tic - throat clearing, grunting low self-esteem often develops 2/2 ridicule from other kids

Question 41

interventions for all

Answer 41

Family Therapy Group Therapy Milieu Therapy Behavioral Therapy Cognitive Behavioral Therapy Quiet Room Time Out Play Therapy - kids less than 12 yrs old Mutual Storytelling Therapeutic Games Bibliotherapy Therapeutic Drawing Psychopharmacology

Question 42

Enuresis - what age is not normal?

Answer 42

repeated voiding of urine into the bed or clothes -not normal past age of 4.

Question 43

Encopresis (pres)

Answer 43

repeated passing of feces into inappropriate places (e.g. bed or the corner of the room)

Question 44

elimination disorders - causes

Answer 44

Constipation is a major cause of both enuresis and encopresis. Assess and treat for this first!

Question 45

what nanda for CD (CDs are defensive)

Answer 45

defensive coping

Question 46

separation anxiety disorder - treatment

Answer 46

use desensitization, CBT strong genetic component (e.g. parents with panic d/o)

Question 47

autism - speech

Answer 47

stereotyped and repetitive use of language inflexible adherence to routine stereotyped or repetitive motor mannerisms (e.g.spinning) picky eaters, might wear sunglasses. spinners are hyporespontsive to vestibular.

Question 48

autism - flexibility

Answer 48

intolerance for environmental changes (e.g. bed moved) impairment in forming peer relationships - can’t go from parallel play (w/ other kids) to imaginary interactive play. usually around age 2 or 3. sensory integration issues

Question 49

elimination disorders - treatment (elimination bell)

Answer 49

Behavioral therapy (e.g. bell and pad technique) can be helpful for enuresis Assess for stressors, esp with encopresis. Therapy can be helpful.

Question 50

ASD

Answer 50

autism spectrum disorder

Question 51

ADHD - age of onset

Answer 51

7 yrs old

Question 52

copralalia

Answer 52

tourette's - curse words