I.

DIFFERENTIATE AUTISM AND ADHD AUTSIM Definition ADHD

Pervasive and usually severe impairment of reciprocal Characterized by inattentiveness, over activity, and social interaction skills, communication deviance, and impulsiveness. ADHD is a common disorder, restricted stereotypical behavioral pattern. especially in boys. Causes Autism does have a genetic link; many children with a. A combination of factors, such as environmental autism have a relative with autism or autistic traits. toxins, prenatal influences, heredity, and damage Controversy continues about whether or not measles, to brain structure and functions, is likely mumps and rubella (MMR) vaccinations contribute to responsible. the development of late-onset autism. b. Prenatal exposure to alcohol, tobacco, and lead and severe malnutrition in early childhood increase the likelihood of ADHD. Although the relation between ADHD and dietary sugar and vitamins has been studied, results have been inconclusive. c. Brain images of people with ADHD have suggested decreased metabolism in the frontal lobes, which are essential for attention, impulse control, organization, and sustained goal-directed activity. Studies also have shown decreased blood perfusion of the frontal cortex in children with ADHD and frontal cortical atrophy in young

adults with a history of childhood ADHD. Another study showed decreased glucose use in the frontal lobes of parents of children with ADHD who had ADHD themselves. Evidence is not conclusive, but research in these areas seems promising. d. There seems to be a genetic link for ADHD that is most likely associated with abnormalities in catecholamine and possibly serotonin metabolism. Having a first-degree relative with ADHD increases the risk of the disorder by four to five times that of the general population. Despite the strong evidence supporting a genetic contribution, there are also sporadic cases of ADHD with no family history of ADHD; this furthers the theory of multiple contributing factors. e. Risk factors for ADHD include family history of ADHD; male relatives with antisocial personality disorder or alcoholism; female relatives with somatization disorder; lower socioeconomic status; male gender; marital or family discord, including divorce, neglect, abuse, or parental deprivation; low birth weight; and various kinds of brain insult. Clinical Manifestations a. Inattentive behaviors such as misses details, makes a. With few facial expressions toward others

b. c. d. e. f. g.

Do not use gestures to communicate Do not relate to peers or parents Lack spontaneous enjoyment Have apparently no moods or emotional affect Cannot engage in play or make-believe with toys Little intelligible speech. h. Engaged in stereotyped motor behaviors such as hand- flapping, body-twisting, or head-banging

careless mistakes, has difficulty sustaining attention , doesnt seem to listen , does not followthrough on chores or homework, has difficulty with organization, avoids tasks requiring mental effort, often loses necessary things, is easily distracted by other stimuli, is often forgetful in daily activities b. Hyperactive/impulsive behaviors such as fidgets often, leaves seat (e.g., during a meal), runs or climbs excessively , cant play quietly, is always on the go, driven, talks excessively, blurts out answers, interrupts, cant wait for turn, is intrusive with siblings/playmates

Management a. The goals of treatment of children with autism are a. The most common medications are to reduce behavioral symptoms and to promote methylphenidate (Ritalin) and an amphetamine learning and development particularly the compound (Adderall). Methylphenidate is effective acquisition of language skills. in 70% to 80% of children with ADHD; it reduces b. Comprehensive and individualized treatment hyperactivity, impulsivity, and mood lability and including special education and language therapy is helps the child to pay attention more associated with more favorable outcomes. appropriately. c. Pharmacologic treatment with antipsychotics such b. Dextroamphetamine (Dexedrine) and pemoline as haloperidol (Haldol) or risperidone (Risperdal) (Cylert) are other stimu- lants used to treat ADHD. may be effective for specific target symptoms such The most common side effects of these drugs are as temper tantrums, aggressiveness, self-injury, insomnia, loss of appetite, and weight loss or hyperactivity, and stereo- typed behaviors failure to gain weight.

Other medications such as naltrexone (ReVia), c. Methylphenidate, dextroamphetamine, and clomipramine (Anafranil), clonidine (Catapres), and amphetamine compound are also available in stimulants to diminish self- injury and hyperactive sustained-release form taken once daily; this and obsessive behaviors have had varied but eliminates the need for additional doses when the unremarkable results. child is at school. Because pemoline can cause liver damage, it is the last of these drugs to be prescribed. d. Giving stimulants during daytime hours usually effectively combats insomnia. Eating a good breakfast with the morning dose and substantial, nutritious snacks late in the day and at bedtime will help the child to maintain an adequate dietary intake. e. When stimulant medications are not effective or their side effects are intolerable, antidepressants are the second choice for treatment such as Atomoxetine (Strattera). f. Effective approaches include providing consistent rewards and consequences for behavior, offering consistent praise, using time-out, and giving verbal reprimands. Additional strategies are issuing daily report cards for behavior and using point systems for positive and negative behavior. g. In therapeutic play, play techniques are used to understand the childs thoughts and feelings and

to promote communication. This should not be confused with play therapy, a psychoanalytic technique used by psychiatrists. Dramatic play is acting out an anxiety-producing situation such as allowing the child to be a doctor or use a stethoscope or other equipment to take care of a patient (a doll). Play techniques to release energy could include pounding pegs, running, or working with modeling clay. Creative play techniques can help children to express themselves, for example, by drawing pictures of themselves, their family, and peers. These techniques are especially useful when children are unable or unwilling to express themselves verbally.
a. b. Nursing Care Learn what the child likes and dislikes and what will a. Ensuring the childs safety and that of others Stop help keep him calm. unsafe behavior. Provide close supervision. Understand that interruptions in the child's daily b. Give clear directions about acceptable and routines are very stressful, so try to schedule unacceptable behavior. appointments at a time with the shortest waiting period. c. Improved role performance Limit the number of health care workers the child d. Give positive feedback for meeting expectations. encounters at one time. Manage the environment (e.g., provide a quiet place Watch the environment you bring to the child into free of distractions for task completion). because too much sensory stimuli can exacerbate e. Simplifying instructions/directions. symptoms and prompt tantrums. f. Get childs full attention. Break complex tasks into Maintain a quiet, calming environment that's free of small steps. Allow breaks.

c. d.

e.

excess equipment, lighting, and clutter. g. Structured daily routine Establish a daily schedule. f. When performing procedures, explain in simple term. If Minimize changes. possible, simultaneously demonstrate what you're about h. Client/family education and support. Listen to to do because children with autism are visual thinkers. parents feelings and frustrations. Have patience and give the child time to process what you're telling him. Attempt to distract him during procedures and always provide positive reinforcement. g. Avoid frequently saying "no" because this can sometimes lead to tantrums and aggressive behavior. Telling the child what to do rather than what not to do may be a better approach. II. NURSING CARE PLAN OF A CLIENT WITH ADHD ASSESSMENT Short attention span High level of distractibility Labile moods Low frustration tolerance Inability to DIAGNOSIS Impaired social Interaction related to increase level of distractibility PLANNING After 8 hours of nursing intervention, the client will demonstrate acceptable social skills while interacting with staff nurse and family members. INTERVENTION Provide an environment as free from distractions as possible. Institute interventions on a one-toone basis. Gradually increase the amount of environ- mental stimuli. Engage the clients attention before giving instructions (ex. call the clients name and EVALUATION Goal Met. After 8 hours of nursing intervention, the client demonstrated acceptable social skills while interacting with staff nurse and family members.

complete tasks Inability to sit still or fidgeting Excessive talking Inability to follow directions

establish eye contact). Give instructions slowly, using simple language and concrete directions. Ask the client to repeat instructions before beginning tasks. Separate complex tasks into small steps. Provide positive feedback for completion of each step. Allow breaks during which the client can move around. Clearly state expectations for task completion. Initially assist the client to complete tasks. Gradually decrease reminders.

Assist the client to verbalize by asking sequencing questions to keep on the topic (Then what happens? and What happens next?).

III.

WHAT IS CONDUCT DISORDER? Conduct disorder is characterized by persistent antisocial behavior in children and adolescents that significantly impairs their ability to function in social, academic, or occupational areas. Symptoms are clustered in four areas: aggression to people and animals, destruction of property, deceitfulness and theft, and serious violation of rules. IDENTIFY THE DIAGNOSTIC CRITERIA FOR CONDUCT DISORDER A. A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three (or more) of the following criteria in the past 12 months, with at least one criterion present in the past 6 months: Aggression to people and animals (1) Often bullies, threatens, or intimidates others (2) Often initiates physical fights (3) Has used a weapon that can cause serious physical harm to others (e.g., abat, brick, broken bottle, knife, gun) (4) Has been physically cruel to people

IV.

(5) Has been physically cruel to animals (6) Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery) (7) Has forced someone into sexual activity Destruction of property (8) Has deliberately engaged in fire setting with the intention of causing serious damage (9) Has deliberately destroyed others' property (other than by fire setting) Deceitfulness or theft (10) Has broken into someone else's house, building, or car (11) Often lies to obtain goods or favors or to avoid obligations (i.e., "cons" others) (12) Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery) Serious violations of rules (13) Often stays out at night despite parental prohibitions, beginning before age 13 years (14) Has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period) (15) Is often truant from school, beginning before age 13 years B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning. C. If the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder. V. EXPLAIN THE ROLE OF THE NURSE IN THE PREVENTION OF CONDUCTION DISORDER Nurses play a big role in preventing conduct disorders to children and adolescents. At the beginning, nurses must educate caregivers to provide the primary needs of the children in order that all developmental stages be achieved. Nurses must provide teachings on child rearing, parental education of, socials skills training to improve peer relationships, conflict resolution, and anger management.