Precious Times Care Plan

Lindsey Parker and Michele Moore

September 28, 2018

H.N. and Family Questionnaire

Please tell us about your family.

○ SN, the mother, is a school teacher at a nearby elementary school. She is the

primary caregiver and a single mother to HN. HN, a caucasian female, will be 5

years old by the end of the year and was officially adopted by SN over the

summer. HN was born with recreational drugs in her system, thus was put into

foster care due to the birth mother’s mental illnesses and inadequacy to care for

her. SN fostered HN for about a year before deciding to adopt her. SN is very

proactive in the care and treatments to help HN succeed. SN is also a part of

various support groups within the community to better learn how to care for HN.

Please tell us about your child(ren)'s special health care needs, medical diagnoses, or conditions.

○ According to her mother, HN has sensory processing disorder, attachment

disorder, and ADHD. HN expresses characteristics of poor coordination, hears

very faint noises that can be extremely irritating to her, hypersensitive to touch

(especially on head and hands), hyposensitive to pain, can be irritable, does not

realize her own strength so she can sometimes play roughly, and has no fear, so

she will talk to strangers and run off. She also chews objects around the house,

although they are working to reduce this infatuation, and has severe sleep issues.
How does your child communicate?

○ HN is vocal and has no trouble vocally communicating. She often can’t modulate

her voice, so when she is speaking too loudly we are to whisper so that she can

better hear the difference. Sometimes she grunts and makes high whining noises

when she is getting frustrated, but we are to ask her to use her voice to tell us

what is wrong.

How can we best interact with and engage with your child(ren)?

○ SN would like for us to interact and play with HN to better increase social skills.

We could also encourage calming activities and exercises that the therapist

recommends, but overall SN wants HN to play because she is four years old and it

is what she enjoys to do. This also gives SN some time to herself since she is a

single parent. SN wants us to learn HN’s typical bedtime routine so that we can

see the time it takes and types exercises implemented to help a child with sensory

processing disorder.

What activities does your child(ren) enjoy?

○ She loves anything to do with Trolls, Frozen, Moana, Paw Patrol,

Ariel/Princesses. She is very active, so she enjoys running, skipping, hopping,

climbing, digging in sand, trampolines, swinging, bouncing, puzzles, and dress

up. She also enjoys simple crafts and coloring.

What would be a special activity or treat that we could do together?

○ She loves collecting rocks, so collecting rocks outside would be special. At

daycare she played with shaving cream and she talked about that for a while after.

HN has a tub of cool sand, and the family has ordered beans and water beads for
 tactile stimulation. She loves the texture of crunchy foods so veggie straws, chips,

and apples are some of her favorite foods if we wanted to bring a snack. She also

likes fruit (grapes, bananas), raisins, applesauce, and chicken nuggets.

Does your child have difficulty following directions? If so, what techniques do you use to help

your child focus on the tasks they need to complete?

○ This is tricky because HN asks for the daily schedule because she wants to know

the exact plan for the day, but will sometimes get overwhelmed with multi-step

directions. It is always unclear of how she will react. SN uses simple commands

and does not list off multiple directions at once. She also gets on HN’s level at

times and looks her in the face when giving directions. If she is being difficult, we

are to be firm in our directions.

Does your child have behavior outbursts? If yes, what events or situations lead to the outbursts?

○ Answer not provided by parent, although we have witnessed a few outbursts when

play time was over and it was time to start getting ready for bed. We did discuss

how to soothe if an outburst occurs.

What soothes your child if they become upset?

○ Light touch is calming to HN such as running fingers down her arms and back.

We were also told to embrace her in a hug, do joint compression exercises, cookie

rolls, and wheelbarrow walks. These are all distraction techniques that stimulate

her touch receptors. More calming ideas recommended by her therapist include

slow rocking, sucking (popsicle), pushing on walls with different body parts, deep

pressure, massage, hugs, and carrying or lifting heavy things.

Has your child ever tried to hurt themselves or someone else?

○ One time she bit herself because she was overstimulated and frustrated that she

could not fall asleep. She has never seriously hurt someone else, but you have to

let her know if she is playing too rough. She will get into shoving wars in her

class occasionally.

Does your child have a tendency to wander off? If yes, how do you prevent your child from

wandering off?

○ She is very social and enjoys talking to others-including strangers. One time at the

park she came back with snacks that she took from another family there. SN

recommends taking her to a smaller, less crowded park such as Hillandale or

Westover for safety purposes. They used to use a leash to keep track of HN but

have since discarded it due to age.

Are there any other special needs your child(ren) have that we should be aware of?

○ No other special needs were mentioned. HN attends gymnastics, swimming

practice, visits a counselor, speech therapist, and occupational therapist weekly.

Her goal for us is to interact in a kid-friendly manner and improve social skills.

She wants us to play since HN is in so many appointments each week and wants

her to still be able to do things that she enjoys.

 Care Plan

1. Describe in paragraph form all special health care needs, medical diagnoses, conditions,

or disabilities of this child(ren). For example, if a child has Down Syndrome, a repaired

AV Canal and Asthma you should describe each of these conditions in a separate

paragraph.

Attention deficit hyperactivity disorder

Attention Deficit Hyperactivity Disorder (ADHD) is a brain related syndrome

which is manifested by functions and behaviors that are regulated in a way that interferes

with the individual's functioning and development (National Institute of Mental Health,

2016). This disorder may include chronic alterations in attention, concentration, memory,

motivation and effort, learning from mistakes, impulsivity, hyperactivity, organization,

and social skills (Frank, n.d.). According to the 2016 National Survey of Children’s

Health, 6.1 million American children and adolescents had been diagnosed with ADHD,

thus landing the disorder as the most common neurodevelopmental disorder in children

(Danielson, Bitsko, Ghandour, Holbrook, Kogan & Blumberg, 2018). ADHD is typically

first diagnosed by pediatricians or other primary care physicians (Danielson et al., 2018).

Historically, those diagnosed with ADHD at a young age are more likely to struggle with

academics, have impaired social skills, increased risk of injury and hospital admissions,

increased use of substances, and live in poverty than those without the disorder

(Danielson et al., 2018). The first line of treatment for preschool aged children, like our

precious times child, set by the American Academy of Child and Adolescent Psychiatry

is behavior therapy followed by medication if impairment remains (Danielson et al.,

2018).
Attachment disorder

Attachment disorder is commonly seen in children under the age of five who have

been abused or neglected by caregivers (Hornor, 2008). Reactive Attachment Disorder

(RAD) is recognized in children with disturbed and developmentally inappropriate

behaviors in social settings (Hornor, 2008). Specifically, Disinhibited RAD, refers to the

child’s ability to manifest attachments with anyone without the ability to exhibit

appropriate attachments (Hornor, 2008). For example, a child with this category of RAD

will express familiarity with strangers or those who resemble a parental figure (Hornor,

2008). It is vital for children to be diagnosed and treated at a young age to avoid the

development of long-term mental health disorders, such as conduct disorder, oppositional

defiant disorder, and adult antisocial personality disorder (Guttmann-Steinmetz &

Crowell, 2006). Cognitive and emotional therapies are suggested as treatments.

According to the Mayo Clinic, treatments include encouraging the child and promoting

healthy development by being nurturing, attentive, and caring, provide stable caregivers

to initiate consistency for the child, provide a positively stimulating and interactive living

environment, and address the child’s emotional, physical, and intellectual needs.

Individual and family counseling, education for the child and parents about the

developmental impact, and parenting classes are recommended treatments, as well (Mayo

Clinic, n.d.).

Sensory processing disorder

Sensory processing disorder (SPD) occurs when stimuli, such as the five senses,

are not processed correctly by the brain. SPD also includes the disorder of two additional

senses including body awareness (proprioception) and movement (vestibular) (Arky,

 2018). SPD “exists when sensory signals are either not detected or don’t get organized

into appropriate responses,” and can be compared to a “traffic jam,” preventing the brain

from correctly interpreting data from stimuli (STAR Institute for Sensory Processing

Disorder, 2018). This can create several problems for an individual with SPD to function

well in school, process emotions, and go about day to day life. Some children can exhibit

such behaviors as having an abnormally high or low pain threshold, crashing into people

and walls, and putting inedible things into their mouths (Arky, 2018). The symptoms of

sensory issues are put on a spectrum of severity since they can present in many different

ways, such as an over-response and/or under-response to different stimuli (STAR

Institute for Sensory Processing Disorder, 2018). Children who over-respond to stimuli

are termed sensory cravers. These children, including HN, seem to be addicted to intense

stimulation. Sensory craving children can often be misdiagnosed and inappropriately

medicated for ADHD (STAR Institute for Sensory Processing Disorder, 2018).

2. How do these diagnoses impact the child’s: physical growth, physical abilities, and

psychosocial development? This should be a detailed description of how the child is affected

on a daily basis.

Every morning and evening, HN participates in different exercises in order to

orient her to her surroundings and lessen the impact of her diagnoses. As part of

providing respite care to SN, we took over the bedtime ritual this past week. HN’s

regimen first includes astronaut protocol, then sensory brushing of extremities, followed

by joint compressions and pulls, and lastly, sit-ups. Astronaut training includes HN lying

in various positions on a rotating board and spinning her 20 times counterclockwise and

again clockwise, along with eye tracking exercises. The point of the protocol is to
promote dizziness in order to train the brain to recognize the sensation, and respond by

stimulating her eyes to vibrate. According to her mother, her brain is struggling to

naturally accept the state of dizziness, thus why the exercise must be done multiple times

a day. The other exercises listed are also meant to stimulate the brain to recognize

different types of sensations. Another intervention done nightly is the application of night

cream, which is applied in a massage-like fashion to exhibit deep pressure and relaxation.

She is also held tightly during the bedtime story as another means to exert deep pressure

as a calming measure.

HN’s ADHD and emotional disorder make it hard for her to listen and follow

directions easily. As aforementioned, SN will give HN simple tasks one at a time in order

to keep HN from getting too overwhelmed and distracted. So far, it is not clear that HN’s

physical growth is affected. HN is still very young, but she appears to be the appropriate

size for her age group, especially when compared to the other children in her

neighborhood that come to play with her. HN’s diagnoses also do not limit her ability to

function physically. The child participates in several different activities throughout the

week including swimming lessons, gymnastics/tumbling, and has similar physical

abilities as her peers. Needless to say, HN’s physical ability is not compromised. This is

extremely important to help achieve her psychosocial need for purpose and initiative.

However, not being able to focus properly on any one task for an extended period of time

and requiring a higher level of attention can be detrimental to her ability to form a sense

of initiative (Hockenberry, Wilson, & Rodgers, 2017). Over time this can cause her to

feel a sense of guilt for needing extra attention and special accommodations, while not
 being able to complete any one task in a timely fashion (Hockenberry, Wilson, &

Rodgers, 2017).

3. Is the child's physical growth or mobility affected? How?

As a four year old, HN is still growing and developing. As of right now, she

seems to be the appropriate height and weight for someone her age. HN is hyperactive

and participates well in physical activities. She loves to play outside with friends at

daycare and at her own house. HN is able to walk, run, jump, climb, balance, crawl,

crouch, and much more. However, since HN’s ADHD requires her to be constantly

engaged or moving, she much more prone for injuries and accidents. HN loves to climb

on anything and everything, but often at the cost of her own safety. We have had to

correct her several times and teach her about what is safe and what is not. This is a

normal finding since HN is still at the age where she likes to explore her environment,

but her increase in coordination precedes her increase in judgement and moral

development (Hockenberry et al., 2017). The SPD diagnosis alters her response to pain

and exciting stimulation. Since she is hyposensitive to painful stimuli, she often cannot

make connections as to why certain actions are unsafe, because she cannot always feel

the extent of the consequence. For example, HN can climb up a tree, fall down, and then

get back up as if nothing had happened. This can affect her mobility and growth later if

HN has an injury, such as a fracture, and shows no signs or symptoms of being hurt, and

can end up having a more serious underlying issue. On the other hand, HN loves light

touch down her arms and legs right before going to bed to help relax her and prepare her

to fall asleep.
4. Is the child's ability to communicate affected? How?

HN’s ability to communicate is limited due to her inability to express herself

properly. With HN’s SPD diagnosis, some of the sensations she is feeling can overwhelm

her and lead to temper tantrums, lashing out, and/or screaming and squealing. HN often

has trouble using her words when she can’t do something herself or is frustrated with a

situation. She will stand still and furrow her brow while making a high-pitched whining

noise. Other than the child’s inability to properly express her feelings at times, HN is

very vocal and has an extensive vocabulary for a four-year-old. HN can be engaged in

conversation when it pleases her and can often make up dialogue that she has with her

stuffed animals around her room. HN’s ADHD contributes to her tendency to be

indecisive at times. For example, during one visit HN had just finished dinner and really

wanted us to come upstairs to play in her room. SN had mentioned that HN was very

excited about playing outside while they were in the car on the way home from daycare.

Before we even entered into HN’s room, she decided that she wanted to go outside and

play in her backyard. This can make it very hard to communicate with others in the

future if HN is constantly indecisive.

5. Is the child's ability to interact socially affected? How?

Since HN is only four years old, there does not appear to be a significant

difference in HN’s interactions and behaviors when compared to the peers she associates

with. HN is fortunate to live in a cul de sac with children who range from toddlers to

school age, thus we get to experience first hand how she interacts with peers in different

age groups. She is an included and valuable member of the neighborhood play group. HN

and her friends enjoy similar activities such as blowing bubbles, swinging on her playset,
playing tag, playing hide and seek, climbing in trees and on her jungle gym set, etc., and

she is invited to multiple parties and playdates within the community, as well.

One trait of HN that is portrayed differently than her peers is her inability to

manage her emotions. She possesses the excessive urgency to receive, or play, what she

wants at the exact moment that she requests it. The emotion that she is currently feeling

dominates her thinking. Her mother refers to it as being “emotionally stuck.” For

example, during one of our visits her friends decided to quit playing hide and seek and

play with the bubbles instead. HN became extremely upset because she to search for her

friends during hide and seek. She became very protective over her tubes of bubbles. She

balled up in the corner of the yard crying and when we approached her she jumped up

immediately and said “Na na you can’t catch me” and started sprinting. The impulsivity

of ADHD can be witnessed in this scenario. When she becomes “emotionally stuck” she

may repeat the same phrases for a long-period of time, it is extremely difficult to redirect

her, and her whole demeanor and body language changes. She will say hurtful comments

and say no just to say no. The pattern she expresses during these times parallel that of

regression. Her mother believes that this behavior is partly due to her emotional disorder.

She is delayed in voice modulation, thus she often screams and shrieks loudly

when things do not go how she has planned. When the tantrums and shrieking occur the

older children usually find another area to play in and leave her alone, while the younger

children try to console her. Based on the given circumstance, if her friends continue to

develop while HN’s behaviors remain the same, then she may find it more difficult to

make friends and keep friendships since the tendency of the older children was to walk

away.
 Due to HN’s extensive and time consuming bedtime routine, she is often unable

to play outside for more than an hour on any given night. She also has three to four

therapy appointments on weeknights which further limits the time she is able to socialize.

During daycare hours, she also meets with various trained personnel to help with

behavior modification and developmental components. Therefore, even during daycare,

she is taken away from proper and essential peer interaction. Although the purpose of

these appointments are to be helpful, it can also be detrimental to her socialization skills.

6. Is the child's cognitive functioning affected? How does that make an impact on the child?

HN is able to do many things that is expected of a four-year-old, yet her sensory

processing disorder shows some hindrance in cognitive functioning. If she is in a good

and productive mood, she is able to understand most words and follow directions

coherently. One recent concern involves a visual-cognitive alteration that she is currently

visiting doctors for to be examined and diagnosed. Sometimes her sense of vision appears

normal and other times she does not seem to process images correctly. On one of our

visits, HN showed us the correct placement of puzzle pieces together. These puzzles had

a mat underneath of the puzzle pieces that had the full picture on it. However, on the

following visit, HN seemed to be struggling with fitting the pieces of the same puzzle

onto the mat. At first, HN had the pieces lying in the correct place, but then took them out

and put them in the wrong places because she said “it didn’t look right.” This is believed

to be somehow linked to her diagnoses, but further studies need to be completed. Other

issues are that she often writes her name backwards and can’t tell top from bottom, both

of which have caused delays in her learning her letters and numbers. It is not

developmentally inappropriate for a four-year-old to write their name backwards, but the
 occupational therapist is concerned since this is an issue they have been trying to fix for

over a year. Her difficulty with recognizing letters is also a cause of concern for cognitive

development. Sometimes she recognizes an “A” as an A, and other times she sees it as a

separate letter, such as a M. Comprehension, along with listening skills, are the biggest

area of concerns that we can identify. She also struggles with simple motor planning,

such as thinking ahead to figure out what steps to take to complete a task. For example,

when she gets tired she eats with her fingers rather than a fork, because forks require a

higher level of critical thinking for her. This action can be indicative of how she will

perform in a classroom.

7. What are some other obstacles or barriers do you notice in the child's life that can affect

their growth and development?

Due to the nature of ADHD, HN possesses hyperactivity which causes a barrier to

appropriate four-year-old sleeping patterns. SN reports that there are nights that her

daughter is in bed for hours with the lights off and is still wide awake when being

checked on. This is not due to medication side effects because HN does not currently take

medications to combat ADHD or Sensory Processing Disorder. In fact, she takes a

nightly dose of Melatonin to try to promote sleep. HN also gets very frustrated with not

being able to fall asleep efficiently either, as evidenced by the self-harm biting incident.

Four year olds should be sleeping for at least 12 hours a night, therefore additional

behavioral and developmental issues may occur if less than the required amount of sleep

occurs frequently. Difficulty falling asleep, bedtime resistance, and restlessness during

the night can result in lessened sleep duration and poor sleep efficiency throughout the

night (Owens, 2005). According to Dr. Owens’ study in 2005, “Sleep loss and sleep
fragmentation are also known to have a direct impact on mood; thus, affective symptoms

(e.g. irritability, decreased positive mood) associated with ADHD may also be

exacerbated by sleep problems. Furthermore, because insomnia in children frequently

affects parental sleep and stress levels, health-related quality of life from the parents’ as

well as from the child’s perspective is potentially affected.” SN promotes a bedtime

routine to help HN fall asleep quicker which starts at the same time every night. She also

has a clock in the shape of a sheep whose eyes close when it is time for HN to fall asleep

and whose eyes open during the day, which symbolizes it is time to be awake. This helps

HN to have a regular sleep cycle and establish a routine to produce some normalcy and

ease her anxiety.

Another obstacle we have noticed that can affect HN’s growth and development is

the condition and cleanliness of the house. Everywhere we turn, there are piles of boxes,

papers, and other random items. There is barely even room to sit at the kitchen table.

Having so much stuff around the already small house makes it feel much smaller. Not

only is having stuff piled up from floor to ceiling a health and safety hazard, but it’s also

very distracting and overwhelming, especially for a small child that has special health

care needs. HN is a very active child and needs constant attention, so much of the

cleaning that needs to take place on an almost daily basis does not get to be done until

HN is in bed at around eight o’clock every night. Trying to take care of a preschooler by

yourself, while working full-time and a having hectic evening schedule makes it

challenging for SN to get any time to herself, let alone give the house the proper cleaning

that it needs. We see a potential for caregiver strain in SN if HN continues to struggle

with her behavioral problems or if SN does not find more time to take care of herself,
 which can be an obstacle for the entire family. If SN does not get the time she needs to

take care of herself to either just relax or clean the house, then SN could get burnout and

will make less of an effort to get HN to her different events scheduled throughout the

week, and HN will not get the attention that she so craves.

8. How will adjust your plan of care to meet the various needs of the child during your

visits?

For the first two visits we observed the child, her behaviors, and interactions with

others to gain a clearer sense on how we can be of service to the family. Prior to our

visits, we as partners, organize an activity plan to complete during the visit. Our goal is to

include activities that are age appropriate, promote cognitive and tactile stimulation, and

can be done in a short time span due to the child’s distractibility and inattentiveness. We

always barter with HN that we will start off with her choice of activity and then we will

come inside, wash our hands, and complete our pre-planned activity. We had to adjust the

layout of our visits because when activity changes came without warning it trigger a

meltdown. Now that we have a set plan in the beginning that we can all agree on, we

have not had an outburst related to scheduling. We try to encourage HN to go outside and

we all engage in backyard games with her neighbors. We find it very important to allow

socialization with kids her age since the opportunity is often restricted.

It is understood that HN can be triggered to have behavioral and emotional

outbursts. When the symptoms present we are quick to intervene by promoting one of the

calming techniques that the occupational therapist recommended. We often rely on

diverting attention to something else or asking her to complete a task and praising her

when she does it.

9. Given the parents' and child's goals and expectations for respite care, what is your plan

of care?

We were not given specific respite care instructions by SN. Typically when we

visit she uses the time to clean the house and have uninterrupted phone conversations

with friends, family, and those in her support groups. In order to allow SN to have time to

herself, we try to keep HN occupied with multiple activities and promote limited

interaction with her mom. For the best outcomes of our respite care, we referred to the

Nursing Diagnosis Handbook in regards to nursing diagnoses and interventions that we

could implement to benefit the family dynamic (Ackley, Ladwig, & Flynn Makic, 2017).

Due to the severity of HN’s diagnoses, lack of a supportive partner, and time

sensitivity associated with daily exercises and counseling sessions, we believe that SN

could be at risk of caregiver role strain. We can relieve some pressure and stress by

becoming respite caregivers to allow SN to have time to herself. Our goal is to reduce the

risk of caregiver role strain throughout the fall semester. Our interventions include

arranging intervals of respite care each week, assist SN in finding personal time to meet

her needs, facilitate therapeutic and positive communication with SN regarding her wants

and needs from us, and help her problem solve to meet the needs of her daughter (Ackley,

Ladwig, & Flynn Makic, 2017). Although we have not seen any indications of child

abuse or neglect in the home, we are obligated to observe for evidence of violence. We

will appraise the implementation by assessing the relationship and care given and

received between SN and HN, as well as communicating weekly with SN and asking how

we can better serve their family during the next visit.

 Our next goal is to lessen the risk for developmental delay regarding motor

planning mentioned earlier in the care plan. We have already begun implementing

impactful interventions. One of the activities that we planned included decorating foam

pumpkins with crayons, markers, and stickers to help HN think through a process from

start to finish. Due to her limited attention span, we attempt to promote activities that can

be done in a short time period, while still promoting creativity and motor planning. We

incorporated one of HN’s favorite Disney movies, Frozen, into her pumpkin decorating

by buying Elsa, Anna, and Olaf stickers, along with some other princess stickers

including ones in the shape of a crown, another in the shape of a castle, and the word

“Princess.” We also played the Frozen soundtrack during the activity to make it more

engaging for her, as well as stimulate her sensory input. Through this activity we taught

HN to correctly associate the Fall season with appropriate Fall activities, holidays, and

decorations. One way that we can assess the attainment of our goal is to see if HN can

associate pumpkins with Halloween and the Fall season, as well a similar craft from start

to finish.
 We also believe that HN is at risk for impaired social interaction as mentioned

previously in the care plan (Ackley, Ladwig, & Flynn Makic, 2017). She is typically

egocentric and struggles to share, although these qualities are not inappropriate for her

developmental level. Due to these characteristics and her diagnoses, our goal is to

incorporate increased socialization with peers by providing supervised interaction

opportunities amongst her and her neighbors (Ackley, Ladwig, & Flynn Makic, 2017). To

facilitate our intervention, we bought miniature containers of bubbles that could be

shared amongst her and her friends, so that they could enjoy an activity together that is

pertinent for their ages. When HN became protective over her bubbles, we reminded her

to please share with her friends. Another intervention would be to host a visit at a nearby

park, so that she could interact with children that she does not already know. We will

assess these interventions by monitoring for an increase in her willingness to share and

positive interactions with other children without tantrums and meltdowns. If these occur,

we will re-evaluate how we can better assist in meeting her socialization needs.
 Sources
Ackley, B., Ladwig, G., Flynn Makic, M (2017). Nursing Diagnosis Handbook: An Evidence-

Based Guide to Planning Care (11th Edition). St Louis, Missouri: Elsevier.

Arky, B (2018, August 17). Sensory Processing Issues Explained. Child Mind Institute, Inc.

Retrieved from https://childmind.org/article/sensory-processing-issues-explained/

Danielson, M., Bitsko, R., Ghandour, R., Holbrook, J., Kogan, M., Blumberg, S. (2018).

Prevalence of parent-reported ADHD diagnosis and associated treatment among U.S.

children and adolescents, 2016. Journal of Clinical Child & Adolescent Psychology

47(2), 199-212. Doi: 10.1080/15374416.2017.1417860

Frank, M. (n.d.). ADHD: the facts. Retrieved from https://add.org/adhd-facts/

Guttmann-Steinmetz, S., & Crowell, J. (2006). Attachment and externalizing disorders: A

developmental psychopathology perspective. Journal of the American Academy of Child

& Adolescent Psychiatry 45(4), 440-451. Doi:

https://doi.org/10.1016/j.pedhc.2007.07.003

Hockenberry, M. J., Wilson, D., & Rodgers, C. C. (2017). Wong's Essentials of Pediatric

Nursing (10th ed.). St. Louis, Missouri: Elsevier.

Hornor, G. (2008). Reactive attachment disorder. Journal of Pediatric Health Care 22(4),

234-239. Doi: https://doi.org/10.1016/j.pedhc.2007.07.003

Mayo Clinic (2017). Reactive attachment disorder. Retrieved from

https://www.mayoclinic.org/diseases-conditions/reactive-attachment-disorder/diagnosis-

treatment/drc-20352945
National Institute of Mental Health (2016). Attention deficit hyperactivity disorder. Retrieved

from https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-

adhd/index.shtml

Owens, J (2005). The ADHD and sleep conundrum: a review. Developmental and Behavioral

Pediatrics 26(4), 312- 322.

STAR Institute for Sensory Processing Disorder. (2018). About SPD. Retrieved from

https://www.spdstar.org/basic/about-spd