AUTISM VS.

AD/HD
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Pervasive Developmental Disorder: Autistic Disorder

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Characterized by impairment in social and communication skills and the display of stereotypical behaviors. Autistic disorder is marked by severe deficits in language, perceptual and motor development, defective reality testing; and an inability to function in social settings.

Etiology

The etiology of autism is unknown Abnormal electroencephalograms Epileptic seizures Delayed developmental of hand dominance

Individuals with autism may have:

Persistence of primitive reflexes Metabolic abnormalities Cerebellar vermal hypoplasia - part of brain involved in regulating motion

Autism often is not diagnosed until the age of 2-3, but early signs during infancy detects it like:

>failure to cuddle >failure to make eye contact >failure to exhibit facial responsiveness >unable to play cooperatively >may not reach to be picked up

Clinical Manifestations

> Social relations and behavior > Development > Language > Sensory/Perpetual Processes There is range in severity, from mild forms requiring minimal supervision to severe forms in which self-abusive behavior is common.

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COMMON SYMPTOMS INCLUDE: failure to develop social relations abnormal responses to sensory stimuli inappropriate or decreased emotional expressions specific, limited intellectual problem solving abilities Repetitive use of language (echolalia) impaired ability to initiate or sustain a conversation

Autism
Appearance: Clean, flat, act as deaf Behavior: Ritualistic, insensitive to pain, no fear to death, uncuddly, point s to anything, temper tantrums, solitary play, LABILE mood Communication: Echolalia; giggling laugh NX: Impaired verbal communication; impaired social interaction; risk for injury (directed to self) Nursing Priority: Safety Activity: Non-competitive, monotonous Attitude therapy: Active friendliness

Nursing Management:

There is no cure for autism, however numerous therapies have been used. > promote positive reinforcement > increase social awareness of others > teach verbal communication skills > decrease unacceptable behavior

When these children are hospitalized, the parents are essential to planning of care and ideally should stay with the child as much as possible. Minimum holding and eye contact may be necessary to avoid behavioral outbursts Care must be taken when performing procedures on, administering medicines or feeding these children

ADHD
ATTENTION-DEFICIT HYPERACTIVITY DISORDER
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>>> is a persistent pattern of inattention and/or hyperactivity-impulsiveness reveled before age of 7 Estimated to occur in about 3-7% of children in Associated with child neglect, lead poisoning, and drug exposure in utero THREE MAJOR BEHAVIORS > Inattention makes children unable to complete tasks ineffectively >Impulsiveness causes them to act before they think > Hyperactivity children may shift

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Symptoms

Inattention > often fails to give close attention to details often has difficulty sustaining attention in tasks or play activities Often does not seem to listen Often does not follow instructions Often has difficulty organizing tasks Often avoids, dislikes to engage tasks Often loses things necessary for tasks

Hyperactivity > often fidgets with hands or feet or squirms in seat Often leaves seat Often runs about or climb excessively in situations in w/c inappropriate Often has difficulty playing quietly Often on the go Often talks excessively Impulsivity > often bursts out or answers

Three Subtypes:

1. Combined type (most common) - individual has 6 or more symptoms of all hyperactivity, inattentiveness and impulsiveness. 2. Predominantly inattentive type -6 more symptoms of inattention, fewer in hyperactivity and impulsiveness. 3. Predominantly hyperactive and impulsive type - 6 or more symptoms in hyperactivity

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Important to distinguish ADHD from ADHD normal, active behavior, behavioral signs of psychosocial stressors, inadequate parenting, or other psychiatric disorders such as bipolar disorder Can persist into adulthood Often diagnosed when child starts school or before 7 years old

Treatment
Combination of pharmacotherapy with behavioral, psychosocial, and educational interventions
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(CARD)

Stimulants: pemoline (Cylert) amphetamine compound (Adderall), methylphenidate (Ritalin), an dextroamphetamine (Dexedrine), and Common side effects: insomnia, loss of appetite, and weight loss or failure to gain weight

Nursing consideration

Long term basis in a client of care to help plan and implement therapeutic regimens and to evaluate effectiveness of therapy Explain children taking stimulant medication to take it in the morning Must understand which type of LD a child has in order to provide direction

T O U G H

Strategies techniques -Therapeutic play for Home and -Offering consistent praise School -Using time-out
-Giving verbal reprimands -Helping with parenting strategies

P -Providing consistent rewards and consequences for behavior I -Issuing daily report cards for behavior G -Give point systems for positive and

AD/HD
Etiology Appearance Behavior early malnutrition; prenatal trauma; hereditary; social Dirty, low self-esteem, Clumsy, hyperactive, inattentive

Communication NX

Excessive talking, burst out in class Impaired social interaction; risk for injury (directed to others)

AD/HD Nutrition Treatment Milieu Activity Increase in calories, finger foods Ritalin, Dexedrine, Cylert (CA-R-D) Non-stimulating enviroment Quiet, non-competitive

Attitude therapy Kind firmness

Mental Retardation

Mental Retardation

Mental retardation
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Subnormal general intellectual functioning which originates during the developmental period and is associated with impairment of either learning and social adjustment or maturation or both.

Early behavioral signs

Nonresponsiveness to contact Poor eye contact during feeding Diminished spontaneously activity Decreased alertness to voice or movt Irritability Slow feeding

Causes:
Etiology: unknown Genetic: chromosomal and inherited conditions Developmental: prenatal exposure to toxins and infections Only 2/3 of all individuals with MR, the probable cause is identified Ex. q Down syndrome (trisomy 21) caused by chromosomal abnormality q abnormal accumulation of chemicals interferes with brain development and may lead to MR q Fetus exposed to alcohol, drugs, radiation,

Physical Appearance
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almond-shaped head downward slanted eyes mouthbreathers and prone to respiratory infections imitate others tongue is flabby with deep groves and fissures small head acute leukemia is more prevalent in them short fat hands with usually one palmar line (simian crease); friendly age of death- 30s or earlier thick lips temper tantrums

Classification of mental retardation according to IQ

CATEGORY Borderline mild moderate severe IQ 68-85 52-67 36-51 20-35

Mild (Educable/Moron)
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85% of all persons with mental retardation social and vocational skills for minimum self-support up to sixth grade level social communication skills minimal retardation in sensorimotor areas

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10% of all persons with mental retardation May profit from vocational training Can function in sheltered workshops as unskilled or semiskilled persons up to 2nd grade level Can talk or learn to communicate poor social awareness fair motor development may learn to travel alone in familiar places

Moderate (Trainable/Imbecile)

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Severe(Imbecile)
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3% to 4% of all persons with MR Poor motor development speech is minimal generally unable to profit from training in selfhelp; little or no communication skills Can talk or learn to communicate elemental health habits, self maintenance under complete supervision;

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Profound (Idiot)
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1% to 2 % of all persons with MR Gross retardation; minimal capacity for sensorimotor areas needs nursing care (0-5) Some motor and speech development; may achieve very limited self-care

Nursing Care
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Help parents accept diagnosis of mental retardation Consider the developmental/functional age, not the chronological age

Teach parents/caregivers that they should:

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Protect the child from danger Make the child as independent as his condition will permit Teach the child to refrain from holding their mouths open as this gives them a dull appearance Select attractive, well-fitting clothing, hairstyle and good hygiene practices Eliminate the childs undesirable social traits, e.g. touching their noses and ears, scratching Refrain from scolding because it blocks learning Recognize that temper tantrum as a childs attempt to meet some underlying emotional needs

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Nursing Care
Teach parents/caregivers that they should:
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When teaching the child:

Demonstrate Use pictures for these are valuable teaching aids Start teaching simple things, gradually progressing to complex learning experiences Teach only one thing at a time Repetition and patience are necessary virtues