Child and Adolescent Disorder Mental Retardation Essential feature- is below average intellectual functioning IQ is less than 70%

accompanied by limitation in areas of adaptive functioning such as: o Communication skills o Self-care o Home Living o Social/ Interpersonal Skills o Use of community resources o Self-direction o Academic Skills o Work o Leisure o Health and Safety

LEVEL OF MR 1. Mild/Moron - IQ : 50-55-70 - Educable - 6th grade 2. Moderate/ Imbecile - IQ: 35-40-50-55 - Trainable - Skills: o Take care of their selves o Perform jobs under strong guidance o Can achieve academic skills of 2nd grade 3. Severe/ Idiot - IQ: 20-25-35-40 - Needs close supervision - Skills: o Learn basic hygiene and simple task w/ close supervision 4. Profound - IQ: Below 20-25 - Needs custodial care - Skills: o Supervision NSG INT. 1. Goal: Promote optimum development w/in a family and community setting. a. Promote feelings of selfesteem, worth, and security b. Educate the parents about developmental stages and task 2. Goal: To promote independence by setting goal. a. Teach basic skills in simple terms, simple steps outlined b. Use behavioral modification as a method for behavioral control. c. Use the principles of repetition, reinforcement and routine

`CAUSES: SYMPTOMS: Continued infant like behavior Decrease learning ability Failure to meet educational demand at school Lack of curiosity Maternal Infection Premature Nutritional deficiency Toxoplasmosis Anoxia Lead poisoning Recent infection Thyroid deficiency Alcoholic mother Rh Incompatibility Damage of brain from various causes

Pervasive developmental disorder/ Autism Spectrum Disorder Delay in the development of multiple basic function including socialization and communication Identified around 3 y.o- critical period in children.

4. Absence of delusion, hallucination Nsg Dx Impaired social interaction Nsg Int. 1. Goal: To increase social awareness a. Encourage a significant one to one relationship w/ an adult b. Promote and engage in peer interaction c. Develop play and self-care skills d. Do not force interaction 2. Goal: Teach verbal communication a. Respond to verbalization by telling the child what you do not understand b. Respond to nonverbal care w/ verbal interpretation c. Observe and record w/c is lack in clarity of spoken words d. Use on face approach 3. To decrease unacceptable behavior a. Encourage child to recognize and respond to own physiologic needs and urges b. Encourage of verbalization of body need but do not make issues of it c. Offer fluids and encourage exercise to prevent constipation d. Offer the bathroom at appropriate interval e. Prevent child from hurting self PHARMACOLOGIC MGT 1. Antipsychotic- haloperidol/ riperidol 2. Therapy- Play Therapy

CAUSES: Teratogen Exposure to radiation- Oxygen deprivation, poor maternal nut, alcohol/drug in uterus Rh incompatibility

TYPES: 1. Autistic Disorder - Char by: o Profound disturbance in social functioning delayed communication and development - Identified usually by 18 mos and no later than 3 yrs of age - Main problem: Faulty social skills Dx Criteria 1. Impairment in social interaction 2. Impairment in communication and imaginative activity a. Grow deficit in language development b. Pronominal reversal c. Lack of spontaneous made believe play 3. Markedly restricted stereotypical pattern behavior, interest and activity a. Rigid adherence in routine and rituals b. Repetitive motor mannerism

Retts Disoder/ Retts Syndrome Char by the development of multiple deficits after period of normal functioningProfound case and occur more in girls Developed bet. Birth and 5 mos of age

MANIFESTATION 1. Loss of motor skills and stereotype movement listed 2. Loss of interest in social environment 3. Severe impairment of expressive and comprehensive of language Childhood Disintegrative Disorder Char by marked regression, multiple areas of functioning after at least 2 yrs of apparently normal G and D Typical age of onset ( 3-4 yrs ) Social and communication deficits Rare in girls more in boys

e. Diff. sticking to play in one activity 2. Impulsivity a. Offer acts before thiking b. Shifts excessively from one to another activity c. Diff. organizing work d. Needs frequently supervision e. Frequently calls out in class f. Diff. waiting turns in games/group acitivity 3. Hyperactivity a. Runs about/ climbs on things b. Diff. sitting still c. Diff. staying d. Moves during sleep e. Always on the go Additional char: Nsg Dx Risk for injury NSG INT. 1. Goal: To keep child from having self/others a. Assist child to recognize when he/she feels angry b. Help the child to accept his/her feelings of anger c. Teach pt appropriately expression of angry feelings d. Use time out 2. Goal: To encourage age appropriate, socially acceptable coping skills. a. If hyperactive, make envt safe for continuous large muscle movement Obstinacy Negativism Mood lability Low frustration tolerance Soft neurologic signs- motor perceptual dysfunction

Aspergers Disorder Char by the same impairment of social interaction and restricted stereotype behavior seen in autistic disorder No language/ cognitive delays More on boys

Attention- Deficit Hyperactivity Disorder Char by inattention, over activity, impulsivity Appear (3-7 y.o)

ASSESSMENT 1. Inattetion a. Fails to finish things he/she starts b. Easily destructed c. Does not listen d. Has diff. concentration

b. Provide large motor skills activity c. Provide frequent nut. snacks eat on run Dependent Int. 1. Administer prescribed meds a. Ritalin/ Methylphenidate- CNS stimulants i. S/E: 1. Loss of appetite 2. Wt loss

MANAGEMENT Preschool program- educate parent about G and D School age- tx of child a. Preventing education, social skills training b. Family therapy- family problems c. Individual therapy d. For adolescent who use drugs and alcohol i. Use anger management ii. Use social skills Optional Client Disorder Char: o Loves to bother/ Irritate others

Conduct Disorder Psychiatric category marked by a pattern of repetitive behavior Major problem Lack of empathy Char: Persistent emotional behavior

Symptoms are Clustered by 4 areas/ Criteria 1. 2. 3. 4. Aggressive to people and animal Destruction to property Deceitfulness and theft Serious violation/ Breaking of Rules

Subtypes (2) 1. Childhood onset type - 10 y.o (on set of symptoms) - Considered ANTISOCIAL 2. Adolescent onset type - No behavior of conduct disorder after 10 y.o - Less aggressive to have normal peer relationship 3 Classification of Conduct Disorder 1. Mild- eg. Lying 2. Moderage- eg. Vandalism, Theft 3. Severe- considerable harm to others (eg. Force sex, Use of weapons)