Autism Adhd Mental Retard

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AUTISM VS. AD/HD


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Pervasive Developmental

Disorder: Autistic Disorder- 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.


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Etiology

The etiology of autism is unknownIndividuals with autism may have:

Abnormal electroencephalograms

Epileptic seizures Delayed developmental of hand dominance

Persistence of primitive reflexes Metabolic abnormalities Cerebellar vermal hypoplasia - part

of brain involved in regulating motion


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Autism often is not diagnosed until the

age of 2-3, but early signs duringinfancy 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


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Clinical Manifestations

> Social relations and behavior > Development > Language > Sensory/Perpetual Processes

There is range in severity, from mildforms requiring minimal supervision

to severe forms in which self-abusive

behavior is common.


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COMMON SYMPTOMS INCLUDE:q failure to develop social relationsq abnormal responses to sensory stimuliq inappropriate or decreased emotional

expressionsq specific, limited intellectual problem solving

abilitiesq Repetitive use of language (echolalia)

q impaired ability to initiate or sustain aconversation


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AutismAppearance: Clean, flat, act as deaf

Behavior: Ritualistic, insensitive to pain, no fearto death, uncuddly, point s to anything, tempertantrums, solitary play, LABILE mood

Communication: Echolalia; giggling laughNX: Impaired verbal communication; impairedsocial interaction; risk for injury (directed to

self)Nursing Priority: Safety

Activity: Non-competitive, monotonous

Attitude therapy: Active friendliness


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Nursing Management:

There is no cure for autism, howevernumerous therapies have been used.

> promote positive reinforcement > increase social awareness of others > teach verbal communication skills

> decrease unacceptable behavior


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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


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ADHD

ATTENTION-DEFICIT HYPERACTIVITY DISORDER

q >>> is a persistent pattern of inattention and/orhyperactivity-impulsiveness reveled before age of7

q Estimated to occur in about 3-7% of children inq Associated with child neglect, lead poisoning, and

drug exposure in uteroq THREE MAJOR BEHAVIORSq

> Inattention makes children unable to completetasks ineffectivelyq >Impulsiveness causes them to act before they

think

q > Hyperactivity children may shift


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Symptoms Inattention > often fails to give close attention to

details

often has difficulty sustaining attention intasks 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


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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


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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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ADHDq Important to distinguish ADHD fromnormal, active behavior, behavioral

signs of psychosocial stressors,inadequate parenting, or otherpsychiatric disorders such as bipolar

disorderq Can persist into adulthoodq Often diagnosed when child starts

school or before 7 years old


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Treatment

Combination of pharmacotherapy withbehavioral, psychosocial, and educationalinterventionsq

(CARD)q Stimulants: pemoline (Cylert)

amphetamine compound (Adderall),methylphenidate (Ritalin), an

dextroamphetamine (Dexedrine), andq Common side effects: insomnia, loss of

appetite, and weight loss or failure to

gain weight


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Nursing consideration

Long term basis in a client of care to

help plan and implement therapeutic

regimens and to evaluate effectivenessof 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


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Strategies for Home and

SchoolT -Therapeutic play techniquesO -Offering consistent praise

U -Using time-outG -Giving verbal reprimandsH -Helping with parenting strategies

P -Providing consistent rewards andconsequences for behaviorI -Issuing daily report cards for behavior

G -Give point systems for positive and


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AD/HD

Etiology early malnutrition; prenataltrauma; hereditary; social

Appearance Dirty, low self-esteem,

Behavior Clumsy, hyperactive, inattentive

Communication Excessive talking, burst out

in classNX Impaired social interaction;

risk for injury (directed to

others)


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AD/HD

Nutrition Increase in calories, fingerfoods

Treatment Ritalin, Dexedrine, Cylert (C-

A-R-D)Milieu Non-stimulating enviroment

Activity Quiet, non-competitive

Attitude therapy Kind firmness


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Mental Retardation


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Mental Retardation


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Mental retardation

q Subnormal general intellectual

functioning which originates during

the developmental period and isassociated with impairment of either

learning and social adjustment or

maturation or both.


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Early behavioral signs

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

Irritability Slow feeding


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Causes:

Etiology: unknownGenetic: chromosomal and inherited conditionsDevelopmental: prenatal exposure to toxins andinfections

Only 2/3 of all individuals with MR, the probablecause is identifiedEx.q Down syndrome (trisomy 21) caused by

chromosomal abnormalityq abnormal accumulation of chemicals interferes

with brain development and may lead to MRq

Fetus exposed to alcohol, drugs, radiation,


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Physical Appearance

q

almond-shaped headq downward slanted eyesq mouthbreathers and prone to respiratory infectionsq imitate othersq

tongue is flabby with deep groves and fissuresq small headq acute leukemia is more prevalent in themq short fat hands with usually one palmar line (simian

crease);q friendlyq age of death- 30s or earlierq thick lipsq

temper tantrumsq

Classification of mental


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Classification of mentalretardation according to IQ

CATEGORY IQ

Borderline 68-85

mild 52-67

moderate 36-51

severe 20-35


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Mild (Educable/Moron)

q 85% of all persons with mental retardationq social and vocational skills for minimum

self-support up to sixth grade levelq social communication skillsq minimal retardation in sensorimotor areas


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Moderate

(Trainable/Imbecile)q 10% of all persons with mental retardationq May profit from vocational training

q Can function in sheltered workshops as

unskilled or semiskilled personsq up to 2nd grade level

q Can talk or learn to communicate

q poor social awareness

q fair motor developmentq may learn to travel alone in familiar places


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Severe(Imbecile)

q 3% to 4% of all persons with MRq Poor motor development

q speech is minimal

q generally unable to profit from training in self-

help;

q little or no communication skills

q Can talk or learn to communicateq elemental health habits,q

self maintenance under complete supervision;


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Nursing Care

q Help parents accept diagnosis of mental

retardation

q Consider the developmental/functionalage, not the chronological age


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Teach parents/caregivers that they should:q Protect the child from danger

q Make the child as independent as his conditionwill permit

q Teach the child to refrain from holding their

mouths open as this gives them a dull appearanceq Select attractive, well-fitting clothing, hairstyle

and good hygiene practicesq Eliminate the childs undesirable social traits,

e.g. touching their noses and ears, scratchingq Refrain from scolding because it blocks learning

q 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:q When teaching the child:

Demonstrate

Use pictures for these are valuableteaching aids

Start teaching simple things, gradually

progressing to complex learning

experiences Teach only one thing at a time Repetition and patience are necessary

virtues

Autism Adhd Mental Retard

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