Nur175 Unit 4

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Mental Retardation

Back 1

defined by deficits in general intellectual functioning and adaptive functioning.
DSM-IV-TR identifies criteria for mental retardationas IQ of 70 or below.

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Etiological Factors of Mental Retardation

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Hereditary factors (5%)
Early Alterations in Embryonic Development (30%)
Pregnancy and prenatal factors (10%)
General Medical Conditions Acquired in Infancy or Childhood (5%)
Environmental Influences and Other Mental Disorders (15 to 20%)

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Mild Mental Retardation

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IQ of 50 to 70
Capable of Independent living, with assistance during times of stress.
Capable of academic skills to sixth-grade level. As adult can achieve vocational skills for minimum self support.
Capable of developing social skills. Functions well in a structured, sheltered setting.
Psychomotor skills usually not affected , although may have slight problems with coordination.

Front 4

Moderate Mental Retardation

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IQ of 35 to 49
Can Perform some activities independently. Requires supervision.
Capable of academic skill to second grade level.
As adult may be able to contribute to own support in sheltered workshop.
May experience limitation in speech communication. Difficulty adhering to social convention may interfere with peer relationships.
Motor development is fair. Vocational capabilities may be limited to skilled gross motor activities.

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Severe Mental Retardation

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IQ of 20 to 34
May be rained in elementary hygiene skills. Requires complete supervision.
Unable to benefit from academic or vocational training. Profit from systematic habit training.
Minimal verbal skills. Wants and needs often comunicated by acting out behaviors.
Poor psychomotor development. Only able to perform simple tasks under close supervision.

Front 6

Profound Mental Retardation

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IQ below 20
No capacity for independent functioning. Require constant aid and supervision.
Unable to profit from academic or vocational training. May respond to minimal training in self help if presented in the close context of a one to one relationship.
Little, if any, speech development. No capacity for socialization skills.
Lack ability for both fine and gross movements. Requires constant supervision and care. May be associated with other physical disorders.

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Mental Retardation DIAGNOSES

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Risk for Injury
Self Care Deficit
Impaired Verbal Communication
Impaired Social Interaction
Delayed growth and development
Anxiety (moderate to severe)
Defensive coping
Ineffective coping

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Mental Retardation OUTCOMES

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Client has:
experienced no physical harm
has had self- care needs fulfilled
Interacts with others in a socially appropriate manner.
Has maintained anxiety at a manageable level.
Is able to accept direction without becoming defensive.
Demonstrates adaptive coping skills in response to stressful situations.

Front 9

Autistic Disorder

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characterized by a withdrawal of the chld into the self and into a fantasy world of his or her own creation.
Prevalence of autism spectrum disorders in the US is about 1 in 150 children.
Occurs 5 times more often in boys than in girls.
Onset of disorder occurs before age 3, and in most cases runs a chronic course, with symptoms persisting into adulthood.

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Neurological Implications - Autistic Disorder

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Generally accepted that autism is caused by abnormalities in brain structures or functions.
Abnormalities in the area of the amygdala, which is known to help regulate aspects of social and emotional behavior.
Elevated levels of serotonin have also been found in a number of cases.
Early developmental problems such as postnatal neurological infections are possible implications in the predisposition to autistic disorder.

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Genetics - Autistic Disorder

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strong evidence that genetic factors may play a significant role.

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Perinatal Influences - Autistic Disorder

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Recently found that women who suffered from asthna and/or allergies around the time of pregnancy were at increased risk of having a chile affected by autism.
May be due to maternal immune system during pregnancy, or that asthma and allergy may share environmental risk factors with autism spectrum disorders.

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Background Assessment Data - Autism Disorder

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Children with autistic disorder do not form interpersonal relationship with others. They do not respond to or show interest in people. As infants they may have an aversion to affection and physical contact. Both verbal and nonverbal skills are affected. Language may be totally absent, or characterized by immature structure or idiosyncratic utterances whose meaning is only clear to those who are familiar with the child's past experiences. Nonverbal communication such as facial grimaces or gestures, is often absent or inappropriate for the situation.
Even minor changes in the environment are often met with resistance, or sometimes with hysterical responses.
Attachment to, or extreme fascination with, objects that move or spin is common.
Routine may become an obsession.
Stereotyped body movements such as rocking, hand-clapping, and verbalizations (repetition of words/phrases) are typical.
Diet abnormalities may include eating only few specific foods or consuming an excessive amount of fluids.

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Autism Disorder - DIAGNOSES

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Risk for self mutilation
Impaired social interaction
Impaired verbal communication
Disturbed personal identity

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Autism Disorder - OUTCOMES

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The client:
exhibits to evidence of self-harm
interacts appropriately with at least one staff member
Demonstrates trust in at least one staff member
Is able to communicate
Demonstrates behaviros taht indicate he or she has begun the separation/individuation process.

Front 16

ADHD -
Attention Deficit/Hyperactivity Disorder

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Essential feature of attention-deficit/hyperactivity disorder is a persistent pattern of inattention and/or hyperacitvity-impulsivity that is more frequent or severe than is typically observed in inidividuals at a comparable level of development.
Highly distractible and unable to contain stimuli.
Motor activity is excessive and movements are random and impulsive.
Onset of disorder is difficult to diagnose in children younger than 4 years.
Frequently not recognized until child enters school.
Four to nine times more common in boys than in girls.
May occur in as many as 3-7 percent of school age children.

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What are the sybtypes for ADHD

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ADHD, Combined Type
ADHD, Predominantly Inattentive Type
ADHD, Predominantly Hyperactive-Impulsive Type

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Etiological Implications - Genetics

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supportive evidence of genetic influence
large number of parents of hyperactive children showed sign of hyperactivity during their own childhood.

Front 19

ADHD - Biochemical Theory

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involvement of neurotransmitters is still under invenstigation. Abnormal levels of these neurotransmitters may be associated with the symptoms of hyperacitvity, impulsivity, mood and aggression often observed in individuals with the disorder.

Front 20

ADHD - Anatomical Influences

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alterations in specific areas of the brain in individuals with ADHD (frontal lobes, basal ganglia, caudate nucleus, and cerebellum

Front 21

Prenatal, Perinatal, and Postnatal Factors - ADHD

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links between maternal smoking during pregnancy and hyperkinetic-impulsive behavior in offspring
Intrauterine exposure to toxic substances, including alcohol can produce effects on behavior.
Fetal alcohol syndrome includes hyperactivity, impulsivity, inattention, as well as physical anomalies.

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Environmental Influences

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lead = adverse effects on cognitive and behavioral development
Diet = possible link between foody dyes and additives; etiological roles of both food additives and sugars have been greatly exaggerated

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Psychosocial Influences

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disorganized or chaotic environments or a disruption in family equilibrium may predispose some individuals to ADHD

Front 24

ADHD - Background Assessment Data (symptomatology)

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children highly distractible and have extrenely limited attention spans
Difficulty in forming satisfactory interpersonal relationships
They are disruptive and intrusive in group endeavors.
They have difficulty complying with social norms.
Boundless energy, exhibiting excessive levels of activity, restlessness, and fidgeting.
They experience a greater than average number of accidents.

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ADHD - Diagnoses

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Risk for Injury
Impaired Social Interaction
Low Self-Esteem
Noncompliance with task expectations

Front 26

Psychopharmacological Intervention for ADHD

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CNS stimulants are sometimes given to children with ADHD
Tricyclic antidepressants have been useful for some ADHD symptoms, particularly attention and restlessness.

Front 27

Conduct Disorder

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repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated.
Physical aggresion is common.
Two subtypes:
Chilhood Onset Type - onset of at least one criterion characteristic of conduct disorder prior to age 10; likely to develop antisocial personality disorder in adulthood.
Adolescent Onset Type - defined by the absence of any criteria characteristic of conduct disorder before age 10 years. Less likely tod isplay aggressive behaviors and tend to have more normal peer relationships than those with childhood onset.

Front 28

Biological Influences - Conduct Disorder

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Genetics
Temperament (personality traits that become very evident very early in life and may be present at birth)
Biochemical Factors (alterations in neurotransmitters norepinephrine and serotonin have been suggested by some studies; testosterone)

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Psychosocial Influences - Conduct Disorder

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peer relationships
family influences

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Backgroung Assessment Data (Symptomatology - Conduct Disorder)

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classic characteristic of conduct disorder is the use of physical aggression in the violation of the rights of others.
Stealing, lying, and truancy are common problems. Child lacks feeling of guilt or remorse.
Low self-esteem is manifested by a tough guy image.

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Conduct Disorder - DIAGNOSES

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Risk for other-directed violence
Impaired Social Interaction
Defensive cooping
Low Self-esteem

Front 32

Oppositional Defiant Disorder

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characterized by a pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures that occurs more frequently than is usually observed in individuals of comparable age and developmental level, that interferes with social, academic, or occupational functioning.
Typically begins by 8 years of age, and usually not later than early adolescence.
In a significant proportion of cases, ODD is a developmental antecedent to conduct disorder.

Front 33

Background Assessment Data (Symptomatology) - ODD

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characterized by passive-agressive behaviors such as stubborness, procrastination, disobedience, carelessness, negativism, testing of limits, resistance to directions, deliberately ignoring the communication of others, and unwillingness to compromise.
Other symptoms: running away, school avoidance, school underachievement, temper tantrums, fighting, argumentativeness.
usually, these children do not see themselves as oppositional but view the problem as arising from other who they believe are making unreasonable demands on them.

Front 34

ODD - diagnoses

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Noncompliance with therapy
Defensive coping
Low self-esteem
Impaired social interaction

Front 35

Tourette's Disorder

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essential feature: presence of multiple motor tics and one or more vocal tics, which may appear simultaneously or at different periods during the illness.
Onset of disorder is before age 18 and is more common in boys than in girls.
Symptoms usually diminish during adolescence and adulthood, and in some cases, disappear altogether by early adulthood.

Front 36

Biological Factors - Tourettes

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Genetics
Biochemical Factors (abnormalities in dopamine, serotonin, dynorphin, GABA, acetylcholine and norepinephrine)
Structural factors (dysfunction in the area of the basal ganglia; smaller size of corpus callosum)
Environmental factors - complications of pregnancy; low birth weight, head trauma, CO poisoning, encephalitis

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Symptomatology - Tourette's

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Motor tics may involve the head, torso, and upper and lower limbs.
Initial symptoms may begin witha singly motor tic, most commongly eye blinkinf, or with multiple symptoms.
Vocal tics include various words or sounds sch as clicks, grunts, yelps, barks, sniffs, snorts, coughs, and in abotu 10% of the cases, a complex vocal tic involving the uttering of obscenities.

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Tourette's - DIAGNOSES

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Risk for self directed or other directed violence
Impaires Social Interaction
Low Self Esteem

Front 39

Psychopharmacological Intervention - Tourette's

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Haldol has been the drug of choice for Tourette's.
Other drugs used:
Pimozide (neuroleptic)
Clonidine (alpha-adrenergic agonist)
Atypical Antipsychotics

Front 40

Separation Anxiety Disorder

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essential feature: excessive anxiety concerning separation from the home or from those to whome the person is attached.
Onset may occur anytime before age 18 years and is more common in girls than in boys.

Front 41

Etiological Implications - Separation Anxiety Disorder

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Genetics - some hereditary influence is evident
Temperament - may be related to the acquisition fo fear and anxiety disorders in childhood.
Stressful life events
Family Influences- related to an overattachment to the mother

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Symptomatology - Separation Anxiety Disorder

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Age of onset may be as early as preschool age.
Anticipation of separation may result in tantrums, crying, screaming, complaints of physical problems, and clinging behaviors.
Reluctance or refusal to attend school is especially common in adolescence.
May refuse to sleep away from home.
Worrying is comming, and relates to the possibility of harm comin to self or to the attachment figure.
Specific phobias are not uncommon. Depressed moos is frequently present and often precedes the onset of anxiety symptoms.

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Separation Anxiety Disorder - DIAGNOSES

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Anxiety (severe)
Ineffective coping
Impaired social interaction

Front 44

Separation Anxiety Disorder - OUTCOMES

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Client is:
able to maintain anxiety at manageable level
demonstrates adaptive coping strategies
interacts appropriately with others

Front 45

Abuse

Back 45

maltreatment of one person by another.

Front 46

Battering

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A pattern of coercive control founded on and supported by physical and/or sexual violence of an intimate partner.

Front 47

learned helplessness

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progressing inability to act on her own behalf.
Occurs when individual comes to understand that regardless of his or her behavior, the outcome is unpredictable and usually undesirable.

Front 48

Cycling of Battering

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PHASE1 - The Tension-Building Phase:
the woman sense that the man's tolerance for frustration is declining. Woman may become nurturing and compliant. she denies her anger and rationalizes his behavior.
PHASE2: The Acute Battering Phase:
most violent and the shortest usually lasting up to 24 hours. Most often begins with batterer justifyin his behavior to himself.
PHASE3: Calm, Loving, Respite ("honeymoon") Phase:
batterer becomes extremely loving, kind and contrite. He promises her abuse will never recur and begs her forgiveness. He plays on her feelings of guilt and she desperately wants to believe him.

Front 49

Emotional abuse

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pattern of behavior on the part of the parent or caretaker that results in serious impairment of the child's social, emotional, or intellectual functioning.

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Physical neglect

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includes refusal of or delay in seeking health care, abandonment, expulsion from the home or refusal to allow a runaway to return home, and inadequate supervision.

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Emotional neglect

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refers to chronic failure by the parent or caretaker to provide the child with hope, love, and support necessary for the development of a sound, healthy personality

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Expressed Response pattern

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rape victim expresses feelings of fear, anger and anxiety through such behaviors such as crying, sobbing, smiling, restlessness, and tension

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Controlled Response pattern

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rape victim's feelings are masked or hidden, and a calm, composed, or subdued affect is seen.

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Compounded Rape Reaction

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additional symptoms such as depression and suicide, substance abuse, and even psychotic behaviors may be noted.

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Silent Rape Reaction

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victim tells no one about the assault. Anxiety is suppressed and the emotional burden may become overwhelming. Unresolved sexual trauma may not be revealed until it reacitivates in another sexual crisis.