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103 Cards in this Set
- Front
- Back
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culture vs. race vs. ethnicity
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culture-learned,shared, integrated, always changing
race-biological classification, does not change ethnicity-a cultural groups indentification |
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what are the health conditions r/t these racial groups
black asian caucasian hispanic native american |
black-diabetes, sickle cell, lactose intol
asian-cleft lip, lactose intol white-celiac, crohns, cf, thalassemia hispanic-diabetes, lactose native american-alcoholism, diabetes, OM |
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What are the 6 elements that demonstrate cx competance
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1-altering ones worldview-rejecting your known biases
2.increase knowledge about cx groups you work with 3.develop a trusting client/provider relationship (bilingual staff) 4. become familiar with cx health beliefs for a certain group 5. develop health goal 6. know core issues of a culture ie. personal space, eye contact etc. |
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What is individual variability
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children differ in the extent to which any factor may shape their development and behavior (regardless if its biological or environmental
all kids with down's are different |
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developmental plasticity
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the effects of innate and experiential factors can be augmented or ameliorated by other factors over time
(environmental factors) outcomes are influenced by environment *no developmental influence shld be regarded as rigidly deterministic (even with genetic disorder environment plays large role) |
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epigenetics
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innate factors not dependent on the sequence of base pairs in DNA
*changes in expression of genes outcomes differ with same genetic cause The idea that our genes react to environmental and internal stimuli is referred to as epigenetics. |
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heritability
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numeric parameter used to quantify genetic influence
***Heritability is the proportion of variance in a particular trait, in a particular population, that is due to genetic factors, as opposed to environmental influences or stochastic variation. **.75=75%of phenotype due to genotype Chiodo says if .75=75%chance of having |
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experience expectant
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brain needs appropriate input during sensitive period to develop (ie vision, language)
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experience dependent
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process in which brain and developmental skills are shaped by experience (but don't result in functional impairment if stimuli are never encountered-ie learning to play the piano)
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What is creating a holding environment?
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safe place with boundaries, parents feel safe to articulate fears, challenges or concerns
parents should feel sense of safety, support and trust |
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What is the SHARE framework
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framework to address parent concerns and provide guidance:
set tone hear concerns address risk factors reflect experience empower parent |
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tips for interviewing infant
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arms of caregiver, soft tone, gentle handling
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tips for interviewing toddler
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respect independence
allow active participation encourage exploration |
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tips for interviewing preschool
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egocentric thinking
illness may viewed as punishment ensure not their fault |
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tips for interviewing school age
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more logical thinking
encourage active engagement invite increased responsibility inquire about their life |
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tips for interviewing adolescents
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increased autonomy
confidentiality time alone with teen include parent |
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positive reinforcement vs negative
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prividing something child wants vs
removing a demand (no homework on frid if homework done m to th |
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punishment
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consequences for a behaviors that are negative.
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behavior probs that require referral
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behaviors pervasive across time, person and setting
severe disruption behaviors threaten safety occur in context of pschy stressors parents dont agree on mgmt |
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time outs
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2 min until 5 then 1 min/year
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good sleep hygiene
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dark, quiet, cool room
regular schedules put to bed drowsy but awake quiet time before bed soothing routine avoid meals or hunger around bedtime |
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How do cognitive and motor skills develop
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from simple to complex
**development for all children follows predictable sequence (but may be at a variable rate ie walking at different ages) |
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critical periods
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dev periods in which child is particulary susceptible to particular influences.
ie not getting consistent predictable care from one person in first year of life=person will find it difficult to develop loving attachments later in life ie language is also a time dependent process |
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characteristics of temperament
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activity
rhythmicity (routine) approach (new situation) adaptability intensity mood distractibility attention span threshold of responsiveness |
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Evaluation of development, what do NP's need to know
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hx (fam, social, prenatal, med)
injuries home environment social environment school progress orphanage present hx |
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fetal alcohol syndrome
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1. prenatal or post natal growth restriction
2. facial dysmorphology (short palpebral fissure,broad philtrum, thin upper lip) 3. CNS involvement |
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evaluation categories for behavior and development
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motor
cognition language socioemotional |
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Why is knowing developmental theories important
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recog of incorrect dev stage
may be important for dx earliest possible dx for intervention effectiveness stages learning specific-if pass through them, learning more difficult |
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risk for developmental delays
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prenatal drug exposure
premie hypoxic injury neuro injury chronic OM metabolic disorder sz, genetic disorder neglect |
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patterns of alcohol use
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mod drinking med <or =2 drinks per day
women < or = 1 drink per day |
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alcohol abuse
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> or = 1 event in 1 yr
failure to fulfill obligation use in hazardous situation legal probs continued use despite personal/social related probs |
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alcohol dependence
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tolerance
withdrawal sympt lots of time spent getting using or recovering from activities given up to drink can't stop drank more that intended |
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what is the audit questionnaire
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Alcohol use disorders identification test: helps detect less severe alcohol probs (hazardous and harmful drinking)
sensitive to current alcohol probs as opposed to past covers: consumption, behavior and dependence, adverse consequences quantitative form that has number for response for no individual interpretation |
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TACER
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alcohol screening test
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at risk drinking
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men >14 drinks per week or >4 on occasion
women >7 per week or >3 on occasion |
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FASD
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most prevalent preventable cause of mental retardation and developmental disorders
1.5 cases per 1,000 live births |
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teen cocaine use predictors
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prenatal cocaine exposure
current caregiver cocaine use |
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what are the stages in family development
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1:launching the single adult
2:joining families through marriage 3:families with young kids 4:families with adolescents 5:launching children and moving on 6:families in later life (retirement til death) |
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child abuse and neglect
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abuse-physical injury- even if parent didn't intend harm
neglect-failure to provide for a child's basic needs |
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What are the health effects of violence
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changes in brain structure-physical and emotional, social dysfunction
1/3 will abuse own children can lead to drug use #1 indicator of how child will do is maternal response |
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What risk factors contribute to child maltreatment
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child disabilities
social isolation parent's lack of understanding hx of abuse low intelligence teen mom poverty substance abuse/ depression parent stress and mental conditions young single non-biological parent |
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When should women be screened for IPV (intimate partner violence)
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every women at q visit
use AAS (abuse assessment screen) if positive answers: show concern say not their fault refer/help |
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screening for abuse/ neglect
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med hx important like hosp, injuries, repeat visits to ER,
keep in mid developemntl stage use child's words when documenting screen for IPV=increase incidence of child abuse with couple with ipv |
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red flags for abuse/neglect
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freq ER visits
incidental finding of injuries or injuries in various stages of healing bruises in atypical places like: hands, feet, abdomen, chest, buttocks bruises in not yet mobile child bruises in shape of object |
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most significant health threat to children
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unintentional injury
#1 cause is MVA (make parent aware of need to be restrained) |
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risk factors for unintentional injury
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age
physical disabilities temperment male poverty busy street permissive parenting firearms in house |
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safety questions
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helmets
home childproofed seatbelts smoke detectors sun exposure water safety strangers guns handwashing lead questions |
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infant safety issues
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choking
burns falls car seat body temp issues sunburn bath 6-12mos chemical ingestion |
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toddler safety issues
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GUNS
burns sunburn MVA abuse (stranger safety) |
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preschooler safety concern
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added abuse
stranger safety |
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school aged child safety concern
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mva
bike no ATV's drowning fires guns sunburn falls suffocation, strangling (playgrounds, old appliances) poisonings abuse po |
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adolescent safety
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MVA
guns drwning fires abuse self injury alcohol drug use sexual activity |
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assessing sexual abuse
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parent and child need to be interviewed separately
ask open ended question to child-"what happened" STD's are diagnostic behavioral indicators are: phobias, poor school performance, regression, phobias,cutting, sleep probs |
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What are the 5 streams of development
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gross motor
visual motor speech/language social adaptive skills |
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abnormal development involves a disturbance of what in regard to acquisition of milestones
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altered timing
altered order or altered sequence |
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developmental quotient
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measure of the rate of development within a stream
tool by which delay is determined divide developmental age/chronological age 12 mo old who can only sit 6/12*100=50 50=poss CP 50-70=delay ***if <70 shld have evaluation motor deficits present in second 6 mos of life |
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primitive reflexes and when they disappear
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Any that persist past 6 mos is abnormal
blink-stays rooting-3 wks sucking-4 mos moro-startle 6 mos palmar grasp-3-4mos tonic neck-fencing pose with turned head stepping-varies babinski-fanned toes 8-12mos |
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visual motor development
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non verbal abilities dependent upon cogntive fxn
ie reaching for objects, follows predictable pattern and time r/t fine motor *if delay noticed but no visual or motor probs identified then its likely there is a cognitive deficit *sensory probs usually detected in first mos of life (vision and hearing) |
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speech development and milestones
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if hearing prob there will be speech prob
cognition and attention prob influence speech acquisition coo 3 mos mama 8 mos understands no 10 mos follow command 12 mos 7-10 wrds-18 mos 24 mos- 50 words 36 mos- 250 words **delays=need for hearing eval delays in communication present at 27-32 mos |
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receptive language vs. expressive lanuage
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ability to understand what is said to you
ability to express your thoughts orally |
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pragmatic language
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ability to derive meaning from the tone or voice rather than word meaning- required for understanding humor, sarcasm etc.
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social and adaptive development
give examples of milestones |
dependent on other streams
subject to enviroment and cx inflences feeding, dressing, toileting, peek a boo, play milestones |
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Define developmental delay
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significant lag in the attainment of milestones
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define developmental disassociation
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significant difference btwn dev rates of 2 streams of dev, with 1 stream more significantly delayed
ie learning disablility-big difference btwn intelligence and academic achievement |
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define developmental deviance
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nonsequential unevenness in the achievement of milestones (achieving harder milestones in typical sequence prior to achieving more simple ones)
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capute's triangle
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model for making developmental dx
disorders exist across 3 streams motor cognitive social behavioral *primary dev dx in 1 stream generally accompanied by deficits in another *do not look at diagnostic criteria and behaviors in isolation of the individual disorder |
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identification of cognitive problems
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harder to identify early compared to motor and language probs
cues are indirect could be something else infancy-look at object permanance, how they manipulate object, ask them what they do with preschool-colors, symbolic play school age and teens-problem solving ,teens can abstract think. |
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intellectual disability
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replaces mental retardation
3 criteria iq <70 significant limit in adaptive functioning onset before 18 y o |
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prader willi
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microdeletion of chromosome
infants have ftt and hypotonia then by 2-obesity, short stature, almond eyes, thin upper lip, low to mod intellectual disability OCD tendencies |
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Angelman syndrome
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deletion on maternal chromosome
severe cog impairment,expressive>recept language impairment, mvmt disorder, happy demeanor, small head, sz |
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williams syndrome
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preorbital fulllness
heat disease 75% iq disability vocab ok, prgmatic language poor |
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smith-magenis syndrome
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chromosome deletion
common behavior probs hyperactive, aggressive, sleep probs self-injurious social skills a strength midface hypoplasia hearing impairment |
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borderline IQ
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70-89 IQ
23% OF POP |
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screening vs. surveillance
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screen is administering brief standardized tool (done at 9,18,24,30 and 48 mos)
surveillance- continuous and cumulative process aimed at identifiying children who may have devel probs and is performed at every well visit |
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sensitivity vs. specificity
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sensitivity-more sensitive-picks up everyone, more false pos
specificity-so specific, more false neg |
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phonological or articulation disorder
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speech disorder where there is substitution, omission, or distortion or phonemes (smallest unit of sound that change meaning of word- map to mop)
**most common |
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dysarthia
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speech disorder
motor speech disorders (physiological probs) seen with CP weakness in speech sound production |
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apraxia
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probs with articulation, phonation (utterance of sound through vocal crds), respiration
speech disorder often result of head injury-not due to weakness in oral musculature like dysarthia where kids also have prob with chewing, swallowing etc |
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example of speech fluency disorder
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speech disorder-
stuttering |
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syntax vs. semantics
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syntax-set of rules grammer
semantics-meaning or words and sentences |
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speech disorder vs. language disorder
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speech-reflect probs with creating appropriate sounds.
language-(aka specific language impairment)-is impairment in ability to understand and/or use words in context (verbally and non-verbally- they can be expressive- trouble sharing thoughts, receptive-trouble understanding others or mixed disorders) |
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What does pervasive developmental disorders include
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autism
aspbergers retts childhood disinegrative disorder pervasive dev disorder not otherwise specified |
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core impairments in kids with ASD's
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reciprocal social deficits
communication deficits restricted/repetitive behaviors |
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general characteristics of autism
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20-35 have regression
40-55 have IQ deficit tic disorders 20-35% epilepsy adhd symptoms sleep probs gi probs |
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when should you screen for autism
what are the screening tools |
general dev screen at 9,18, specific screen for autism at 24-30 mos
autism behavior checklist m-chat hearing test and genetic recommended no metabolic or imaging studies necessary |
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educational interventions for autism
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eclectic approaches best-minimize deficits and maximize functional independence
applied behavior analysis-modification of behvior through reward system **meds not effective unless has comorbid condition |
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applied behavior analysis
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tx for autism
** (ABA) is a method of analyzing and modifying the behaviors of individuals using positive reinforcement |
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etiology of ADHD
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75% phenotype due to genotype
imbalance of neurotransmitters delayed cortical development |
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recommendations for adhd (inital when suspected)
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eval
dx take infor from parent and teacher assessment for coexisting conditions physical exam shld be done-labs not needed |
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tx for adhd
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medication-not based on wt, may need increase, SE's will go away
behavior modification |
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pediatric symptom checklist
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screen for anxiety and mood disorders in children
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treatment for anxiety
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CBT-cognitive behavior therapy-relaxing, exp to feared situations, teaches problem solving and cognitive restructuring.
pharm and CBT most effective |
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SCARED
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screen for child anxiety related disorders (GAD, social, separation and school avoidance)
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mood disorder
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biologic, genetic and environmental cause
rate higher in females comorbidity common (substance abuse, anxiety) 3rd leading cause of death in teens assessment-children's depression inventory |
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Piaget
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adaptation-cognitive dev
sensorimotor-til 2 y.o.learn thro senses (assim-using currently dev schemes to interpret world) (accom-dev new schemes prn) preop stage-2-7yo:egocentric, their perspective, focus on 1 aspect, cant organize into classes, begins to use memory .concrte op 7-11:order items, reasoning, still have prob with abstract thought formal op 12-21: abstract/logical |
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Erikson
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psychosocial devel, identities validated
trust vs mistrust:0-1basic needs autonomy vs shame 2-3 yr-independence initiative vs guilt-morals, exploring. Industry vs inferiority 7-12:wants to achieve, feels inferior when doesnt. identity vs role confusion 13-19:how they look |
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bipolar
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increased energy
distractability irritability racing thoughts euphoria decreased need for sleep needs meds and psych young mania rating scale shows remission and relapse. |
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individual with disablities act
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will get help for learning disability but has to wait to fail
need IQ and achievement discrepancy |
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response to intervention
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process, allows for earlier identification of LD's
identified as LD-when response to a validated intervention is found to be inferior to that of peers. tier based 1. general ed 2. small group tutoring 3.special ed, individual programming |
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section 504
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calls for special accommodations
must have IAP individual accomodation plan (child receives services in a regular classroom-extra time for tests, shorter homework assignments etc) |
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IEP
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individualized education plan (modified curriculum)
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ASKED model of cx competence
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awareness-aware of bias
skill-gather cx knowledge with skill knowledge-know cx health aspects encounters desire |
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kohlberg
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stages of moral development
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