Neurodevelopment in children

Question 1

what are the most common disorder among children

Answer 1

ADHD
Mood disorders
Major Depression

Question 2

what are some effects of childhood mental illness

Answer 2

Long-term mental disorders in adulthood
Thwarted development
Diminished productivity
Conflict within family and in community
Child welfare involvement
Juvenile justice involvement
Special education resources needed
Physical health impairments

Question 3

risk factors of mental illness in children

Answer 3

Biological factors
–Genetic predisposition
–Neurobiological
Psychological factors
–Temperament
Environmental factors
–Abuse or trauma
–Low socioeconomic status
–Parenting

Question 4

what is resiliency

Answer 4

ability to adapt to change or adversity, protective against depression and anxiety

Question 5

protective factors by incrreasing resilience

Answer 5

Positive self-image
Family cohesion& absence of discord
Support from significant others.
Positive relationship with at least one parent
Positive early family experiences with development of social competence.
Family support to help with environmental stressors.
Academic achievement
Positive peer relationships
Temperament

Question 6

role of nurse in children with mental health

Answer 6

Doing a thorough assessment
Early identification is KEY!
Identifying family needs
Promoting children’s rights in treatment settings
Avoiding seclusion & restraint

Question 7

who provides better information about internal symptoms during interview

Answer 7

child (mood, sleep, SI)

Question 8

who provides better info about external symptoms

Answer 8

parent (behavior, relationships)

Question 9

assessment process in children

Answer 9

Children need simple phrases (more concrete)
Corroborate information with adult
Direct questions, rather than open-ended
May use play media
May not be able to provide accurate time-line

Question 10

interviews with preschool

Answer 10

have difficulty putting feelings into words, thinking concretely

Use play; conduct assessment in playroom

Question 11

interviews with school age

Answer 11

able to use constructs; provide longer explanations

establish rapport through competitive games

Question 12

interviews with adolescents

Answer 12

egocentric; increased self-consciousness; fear of being shamed

let them know what info will be shared ; direct, candid approach

Question 13

what does the assessment include

Answer 13

Family functioning: parent-child relationship
Current problem: nature, severity, length; how upsetting? Better/ worse? Triggers/events? Describe behaviors at home, response to discipline, empathy violence, risks
History: previous treatment, family history, developmental & social
Mental status
Physical exam

Question 14

Areas of child development review

Answer 14

Cognitive: ability to learn and solve problems. Ex: a 2-month-old baby learning to explore environment with hands or eyes; a five-year-old learning how to do simple math problems.

Social & Emotional: ability to interact with others, including helping themselves and self-control. Ex. a six-week-old baby smiling; a ten-month-old baby waving bye-bye; a five-year-old boy knowing how to take turns in games at school.

Speech & Language : ability to both understand and use language. Ex. a 12-month-old baby saying his first word; a two-year-old naming parts of her body; or a five-year-old learning to say “feet” instead of “foots”.

Fine motor: ability to use small muscles, specifically their hands and fingers, to pick up small objects, hold a spoon, turn pages in a book, or use a crayon to draw.

Gross motor: ability to use large muscles. Ex. a six-month-old baby learns how to sit up with some support; a 12-month-old baby learns to pull up to a stand holding onto furniture, and a five-year-old learns to skip.

Question 15

Developmental assessment areas

Answer 15

Intellectual functioning
Gross motor functioning
Fine motor functioning
Cognition
Thinking and perception
Social interaction and play

Question 16

Basic Principles of children’s behavior

Answer 16

All behavior has meaning
Address the need behind the behavior
Children want to behave and please those they care about
Children with mental health issues often cannot clearly communicate their needs

Question 17

interventions for children and adolescents

Answer 17

Behavioral interventions
Bibliotherapy
Expressive arts therapy
Journaling
Music therapy
Family interventions
Psychopharmacology
Disruptive behavior management
Play therapy

Question 18

Play Therapy

Answer 18

Appropriate for younger children
The “language” of children;
Vehicle for change, expression of feelings, trust, relationship building
Rooted in psychodynamic therapy
A creative and dynamic process that cannot be standardized
Therapist is in role of trusted participant –not aberrant perpetrator.

Question 19

Communication disorders

Answer 19

speech disorders = problem making sounds

Language disorders =
Difficulty understanding or in using words in context and appropriately

May be evident by inability to follow directions

Expressive language disorder

Social communication disorder

Question 20

Motor Disorders

Answer 20

Developmental coordination disorder = impairments in motor skill development

Stereotypic movement disorder = repetitive, purposeless movements for 4 weeks or more

Tic disorders = sudden nonrhythmic and rapid motor movements or vocalizations

Question 21

3 types of Tic disorders

Answer 21

tourettes disorder

persistent motor or vocal tic = more than 1 year

provisional tic disorder = less than 1 year

Question 22

Tx of tic disorder

Answer 22

1. behavioral techniques
2. relaxation strategy
3. Meds = antipsychotics, clonidine, klonopin, fluoxetine and sertraline
4. Deep Brain Stimulation

Question 23

Dyslexia

Answer 23

Reading disorder

Question 24

dyscalculia

Answer 24

math disorder

Question 25

Dysgraphia

Answer 25

written expression disorder

Question 26

Intellectual Development Disorder

Answer 26

Deficits in = intellectual, social, and daily functioning cognitive and social stim can increase functioning if before age 5

Question 27

Autism spectrum disorder

Answer 27

deficits in social interactions and relationships repetitive speech or behaviors obsessive focus on objects routines and rituals resistance to change hyper or hypo reactivity to sensory

Question 28

psychosocial interventions for ASD

Answer 28

treatment programs behavior management parent teaching OT/PT

Question 29

psychobiological interventions for ASD

Answer 29

2nd gen antipsychotics, SSRIs and stimulants

Question 30

ASD Effective Treatments

Answer 30

Build on the child's interests Offer a predictable schedule Teach tasks as a series of simple steps Actively engage the child Engage in highly structured activities Provide regular positive reinforcement of behavior. Teach early communication/social interaction skills. Involve parents – major factor in treatment success! Social skills training: Helps child recognize social cues Teaches ways to reduce stress Uses role-playing to help play like peers. Speech and language therapy.

Question 31

What is ADHD

Answer 31

Persistent pattern of inattention, hyperactivity, and impulsiveness that is pervasive and inappropriate for developmental level

Question 32

ADHD must occur

Answer 32

In at least 2 settings: causing work, social, or educational difficulties for at least 6 months before age 12.

Question 33

3 types of ADHD

Answer 33

Hyperactivity-impulsivity type Inattentive type Combined type

Question 34

ADHD hyperactivity-Impulsivity type

Answer 34

Six or more of the criteria below present for 6 months: Hyperactivity behaviors =Often fidgets; moves feet; squirms in seat; can’t sit still =Leaves seat before excused =Runs about/climbs excessively or at inappropriate times =Difficulty playing quietly (e.g. Board games) =Is often “on the go” or often acts as if “driven by a motor” =Often talks excessively/ non-stop talkers Impulsivity behaviors =Often blurts answers before questions finished; speaks before thinking =Often interrupts or intrudes on others (Butts into conversations or games) =Problem waiting for his/her turn

Question 35

ADHD - Inattentive Type

Answer 35

Six or more criteria are present for 6 months Behaviors of Inattention =Does not give attention to details or makes repeated careless mistakes =Trouble keeping attention on tasks or activities =Often does not seem to listen when spoken to directly =Does not follow through with completion of task/activity =Often has trouble organizing activities =Avoids, dislikes doing tasks that involve mental effort =Loses things, distracted, or forgetful =Easily bored =Disorganized

Question 36

Best results for ADHD treatment

Answer 36

behavioral management & FDA approved meds

Question 37

Using Stimulants for ADHD

Answer 37

Improve attention and FOCUS decrease hyperactivity begin low dose and work up not weight dependent

Question 38

Long acting stimulants

Answer 38

dextroamphetamine/ amphetamine lisdexamfetamine dexmethylphenidate methylphenidate (Daytrana, Metadate CD, Ritalin LA, Concerta

Question 39

INTERMEDIATE ACTING STIMULANTS

Answer 39

dextroamphetamine methylphenidate (Ritalin SR, Methylin ER, Metadate ER)

Question 40

short acting stimulants

Answer 40

methylphenidate (Ritalin) dexmethylphenidate dextroamphetamine amphetamine sulfate

Question 41

S/E of Stimulant Meds

Answer 41

Decreased appetite, headaches, stomachaches, trouble getting to sleep, jitteriness, and social withdrawal. Nervousness, overstimulation, tachycardia or bradycardia, hypertension, restlessness, insomnia, dry mouth, unpleasant taste, diarrhea.

Question 42

what to do if child appears dull or overly restricted

Answer 42

Tx by decreasing dose or changing to different med

Question 43

what to know with dextroamphetamine/ amphetamine

Answer 43

approved over age of 6 cpasule can be opened and sprinkled into applesauce

Question 44

what to know with Daytrana

Answer 44

may cause permanent skin color change patch form worn for 9 hours on hip; continues to work for a few hrs once removed Benefit: felxible amount of time worn and dose

Question 45

what to know with methylin

Answer 45

chewable tab and oral solution

Question 46

what to know with Ritalin LA

Answer 46

capsules can be opened and sprinkled on food

Question 47

what to know with Concerta

Answer 47

only approved over age of 6

Question 48

only approved me for tx of ADHD under 6 years

Answer 48

Dextroamphetamine

Question 49

NON Stim ADHD meds

Answer 49

atomoxetine (SNRI) = used for children >6 yrs bupropion (NDRI) clonidine (Alone or with a stim, especially good if tics present with ADHD) guanfacine imipramine (TCA)

Question 50

S/E of clonidine

Answer 50

Dry mouth, dizziness, mild sedation, constipation. Symptoms usually resolve after several doses.

Question 51

S/E bupropion

Answer 51

Dry mouth, dizziness, nausea, appetite changes, stomach pain, headache, ringing in ears, sore throat, and muscle pain.

Question 52

S/E atomoxetine

Answer 52

Dry mouth, dizziness, nausea and vomiting, decreased appetite, and trouble sleeping; ***observe CLOSELY for SI

Question 53

ADHD Tips

Answer 53

schedule organize everyday items use homework and notebook organizers be specific, clear, and consistent give praise or rewards set and reward small attainable goals

Question 54

Impulse Control disorders

Answer 54

oppositional defiant disorder conduct disorder intermittent explosive disorder

Question 55

oppositional defiant disorder (ODD)

Answer 55

Negative, hostile, defiant, vindictive Pattern of irritable and angry mood. Swearing Mood lability (angry outbursts) Low frustration tolerance (can’t tolerate being told no Interpersonal conflicts (argumentativeness, disobedience, tendency to blame others) They don’t think of themselves as angry or oppositional. Stubbornness; resistance to directions; unwillingness to negotiate with adults; test limits; ignore rules; verbally aggressive; hostile.

Question 56

Risk Factors ODD

Answer 56

Genetic component; family history of mental illness Numerous neurobiological causes identified Environment: family dysfunction; adverse childhood experiences Temperamental

Question 57

Treatment of ODD

Answer 57

Psychosocial interventions-parent training, group therapy, anger management, individual and family therapy, cognitive problem-solving training. Psychobiological interventions-used to control anger and aggression such as divalproex sodium. The FDA has not approved any meds for the treatment of ODD.

Question 58

Conduct Disorder Behaviors

Answer 58

Persistent violation of basic rights of others or major age-appropriate rules or norms Lacks empathy; does not feel guilty Only express remorse, at “being caught” Risk taking behaviors Cruelty to animals Aggressive behavior toward people / animals Disruptive in community Destruction of property

Question 59

Risk Factors of Conduct Disorder

Answer 59

Physical & sexual abuse Inconsistent parenting with harsh discipline Lack of supervision Early institutional living or out-of- home placement Association with delinquent peer group Parental substance abuse Biologic

Question 60

what is intermittent explosive disorder

Answer 60

Inability to control aggressive impulses Mean age of onset is 13-21 years old Leads to problems with Interpersonal relationships Occupational difficulties Criminal difficulties

Question 61

Comorbidity of intermittent explosive disorder

Answer 61

Depressive, anxiety, and substance use disorders Antisocial and borderline personality disorders

Question 62

Risk Factors of intermittent explosive disorder

Answer 62

Neurobiological abnormalities Conflict or violence in family of origin

Question 63

Tx of intermittent explosive disorder

Answer 63

psychosocial pharmacologic

Question 64

Impulse control disorders Psychosocial interventions

Answer 64

Promote a climate of safety for the patient and for others. Establish rapport with the patient. Set limits and expectations. Consistently follow through with consequences of rule-breaking. Provide structure and boundaries. Provide activities and opportunities for achievement of goals to promote a sense of purpose.

Question 65

Child Trauma & stressor-related disorders

Answer 65

Adjustment Disorder Reactive attachment disorder Disinhibited Social Engagement Disorder

Question 66

most prevalent form of child abuse in the US is...

Answer 66

neglect

Question 67

Intervention Stages

Answer 67

Stage 1 Provide safety and stabilization Stage 2 Reduce arousal and regulate emotion through symptom reduction Stage 3 Catch up on developmental and social skills; develop a value system

Question 68

Attachment Disorders

Answer 68

Reactive Attachment Disorder Disinhibited social Engagement Disorder

Question 69

Reactive Attachment Disorder

Answer 69

Child rarely or minimally seeks or responds to comfort social or emotional disturbance by at least 2 of: =minimal social and emotional responsiveness to others =limited positive affect = episodes of unexplained irritability, sadness, or fearfulness at least 1 of the following: =social neglect or deprivation =repeated changes of primary caregivers =rearing in unusual settings

Question 70

Reactive Attachment Disorder Behaviors

Answer 70

Withdrawal, fear, sadness or irritability that is not readily explained Sad and listless appearance Not seeking comfort or showing no response when comfort is given Failure to smile Watching others closely but not engaging in social interaction Failing to ask for support or assistance Failure to reach out when picked up No interest in playing peekaboo or other interactive games

Question 71

Disinhibited Social Engagement Disorder

Answer 71

1st 2 years of life child interacts with unfamiliar adults with 2 of the following: Reduced reservation about approaching unfamiliar adult Overly familiar and violates social/cultural boundaries Doesn’t check back with caregiver Willing to go with unfamiliar person without reservation

Question 72

Severe social neglect in Disinhibited Social Engagement Disorder

Answer 72

caregiver neglect repeated changes of caregiver

Question 73

RAD and DSED Treatment

Answer 73

include primary familial caregiver ensure child: being nutured, responsive and caring Providing consistent caregivers to encourage stable attachment. Providing a positive, stimulating and interactive environment Addressing the child's medical, safety and housing needs. Increasing touch, talk, and socialization: ===Hold, hug, touch, feed, and talk to the child. Use story-telling. Encourage meals with other children and familial caregivers.

Question 74

Adjustment Disorder

Answer 74

reaction within 3 months of exposure to stressor Distress affects ability to function. Reaction is out of proportion to stressor severity. Symptoms end by 6 months. Anxiety Depression Mixed Regressive behaviors in children Fearful or acting out behavior Requires support, understanding and encouragement. Active listening, therapeutic communication skills Assist in increasing coping skills.