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LEARNING DISORDERS
• Is diagnosed when a child’s achievement in reading, mathematics,
or written expression is below that expected for age, formal
education, and intelligence
• Reading and written expression disorder – identified in the first
grade
• Math disorder may go undetected until the child reaches fifth
grade.
• Low self-esteem and poor social skills are common in children with
learning disorders.
• Children with learning disorders are assisted with academic
achievement through special education classes in public school.
Communication Disorders
• Is diagnosed when a communication deficit is severe enough to
hinder development, academic achievement, or activities of daily
living including socialization.
• Expressive language disorder- involves an impaired ability to
communicate through verbal and sign language
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• Mixed receptive language disorder – includes problems of
expressive language disorder along with difficulty understanding
(receiving) and determining the meaning of words ad sentences.
• Both disorders can be present at birth (developmental) or may be
acquired as a result of neurologic injury or insult to the brain
• Phonologic disorder - involves problem with articulation (forming
sounds that are part of speech).
• Stuttering – is a disturbance of the normal influency and time
patterning of speech.
Pervasive Developmental Disorders
Pervasive developmental disorders are characterized by pervasive and
usually severe impairment of reciprocal social interaction skills,
communication deviance, and restricted stereotypical behavioral patterns.
• Autistic Disorder
- The best known of the pervasive developmental disorders, is more
prevalent in boys than in girls, and it is identified usually by 18
month and no later than 3 years of age.
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- Manifestations vary from little speech and poor daily living skills
throughout life to adequate social skills that allows relatively independent
functioning.
-Goals of treatment of children with autism are to reduce behavioral
symptoms (e.g. stereotyped motor behaviors) and to promote learning and
development, particularly the acquisition of language skills. Comprehensive
and individualized treatment, including special education and language
therapy, is associated with more favorable outcomes.
- Pharmacologic treatment with antipsychotics, such as haloperidol (Haldol)
or Risperidone (Risperdal), may be effective for specific target symptoms
such as temper tantrums, aggressiveness, self – injury, hyperactivity, and
stereotyped behaviors.
-Other medications: Naltrexone (ReVia), Clomipramine (Anafranil), Clonidine
(Catapres), and stimulants to diminish self – injury and hyperactive and
obsessive behaviors.
• RETT’S DISORDER
-Characterized by the development of multiple deficit after a period of
normal functioning
-It occurs exclusively in girls is rare and persists throughout life
-Rett’s develops between birth and 5 months of age
-The child loses motor skills and begins showing stereotyped movements
-She loses interest in the social environment and severe impairment of
expressive and receptive language becomes evident as she grows older
-Treatment is similar to that of autism
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• ASPERGER’S DISORDER
-Characterized by the same impairments of social interaction and restricted
stereotyped behavior seen in autistic disorder, but there are no language
or cognitive delays
-Occurs more often in boys than in girls and the effects are generally
lifelong
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- 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.
Cultural Considerations:
- ADHD is known to occur in various cultures. It is more prevalent in Western
Cultures, but that may be the result of different diagnostic practices rather
that the actual differences in existence.
Treatment:
-No one treatment has been found to be effective for ADHD this gives rise to
many approaches such as sugar controlled diets and megavitamin therapy.
- Goals of treatment involve managing symptoms reducing hyperactivity and
impulsivity, and increasing the child’s attention so that he or she can grow
and develop normally
Psychopharmacology:
Medications often are effective in decreasing hyperactivity and impulsiveness
and improving attention; this enables the child to participate in school and
family life.
- The most common medications are Methylphenidate (Ritalin) and an
Amphetamine compound (Adderall).
- The most common side effects of these drugs are insomnia, loss of appetite,
and weight loss or failure to gain weight.
-Giving stimulants during the daytime hours usually effectively combats
insomnia. When stimulant medications are not effective or their side effects
are intolerable, antidepressants are the second choice for treatment.
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- Educating parents and helping them with parenting strategies are crucial
components o effective treatment of ADHD.
-Effective approaches include providing consistent rewards and
consequences for behaviors, offering consistent praise, using time out, and
giving verbal reprimands.
- Therapeutic play – play techniques are used to understand the child’s
thoughts and feelings and to promote communication.
-Dramatic play is acting out an anxiety – producing situation.
Assessment:
History
-Fussy and had problems as an infant or they may not have noticed the
hyperactive behavior until the child was a toddler or entered day care or
school.
- The child probably has difficulties in all major life areas such as school or
play, and he or she likely displays overactive or even dangerous behaviors at
home.
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-there are generally no impairments in this area, although assessment can
be difficult depending on the child’s activity level and age or developmental
stage.
Outcome identification
Treatment outcomes for clients with ADHD may include the following:
• The client will be free of injury
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• The client will not violate the boundaries of others.
• The client will demonstrate age – appropriate social skills
• The client will complete tasks
• The client will follow directions
Intervention
Intervention described in this section can be adapted to various settings and
used by nurses and other health professionals, teachers and parents or
caregivers.
• Ensuring safety
• Improving role performance
• Simplifying instructions
• Promoting a structured daily routine
• Providing client and family education and support
Conduct Disorder
-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 animal,
destructions of property, deceitfulness and theft
-Associated with early onset of sexual behaviors, drinking smoking, use of
illegal substances and etc.
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-Researchers generally accept that genetic vulnerability, environmental
adversity, and factors like poor coping interact to cause the disorder.
-Risk factor include poor parenting, low academic achievement, poor peer
relationships, and low self esteem; protective factors include resilence, family
support, positive peer relationships, and good health.
- the disorder is more common in children who have siblings with conduct
disorder or a parent with antisocial personality disorder, substance abuse,
mood disorder, schizophrenia.
-Poor family functioning, martial discord, poor parenting, and a family history
of substance abuse and psychiatric problems are all associated with the
development of conduct disorder.
Cultural Considerations
-Concerns have been raised that “difficult” children may be mistakenly
labeled as having conduct disorder in high-crime areas; aggressive behavior
may be protective and not necessarily indicative of conduct disorder.
Treatment
-Many treatments have been used for conduct disorder with only modest
effectiveness. Early intervention is more effective, and prevention more
effective than treatment.
-Dramatic interventions, such as “boot camp” or incarceration, have not
proved effective and may even worsen the situation.
-Treatment must be geared toward the client’s developmental age; no one
treatment is suitable for all ages.
-Medications alone have little effect but may be used in conjunction with
treatment for specific symptoms.
Assessment:
History
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-Children with conduct disorder have a history of disturbed relationships with
peers, aggression toward people or animals, destruction of property,
deceitfulness or theft, and serious violation of rules.
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and alcohol is and additional risk to health. Clients with conduct disorders
are involved in physical aggression and violence including weapons
Outcome Identification
Treatment outcomes for clients with conduct disorders may include the
following:
• The client will not hurt others or damage property.
• The client will participate in treatment.
• The client will learn effective problem-solving and coping skills.
• The client will use age-appropriate and acceptable behaviors when
interacting with others.
• The client will verbalize positive, age-appropriate statements about
self.
Intervention
• Decreasing violence and increasing compliance with treatment.
• Improving Coping skills and self- esteem
• Promoting Social Interaction
• Providing Client and family Education
COMMUNITY-BASED CARE
-Clients with conduct disorder are seen in acute care settings only when their
behavior is severe and only for short periods of stabilization. Much long-term
work takes place at school and home or another community setting. Group
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Homes, halfway houses, and residential treatment settings are designed to
provide safe, structured environments and adequate supervision if that
cannot be provided at home.
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rechews and reswallows the food. The regurgitation does not involve nausea,
vomiting, or any medical condition. This disorder is relatively uncommon and
occurs more often in boys than in girls; it results in malnutrition, weight loss,
and even death in about 25% of affected infants.
• Feeding Disorder
-Feeding disorder of infancy or early childhood is characterized by persistent
failure to eat adequately, which results in significant weight loss or failure to
gain weight. Feeding disorder is equally common in boys and girls and occurs
most often during the first year of life. In severe cases, malnutrition and
death can result, but most children have improved growth after some time.
• Tic Disorders
-A tic is a sudden, rapid, recurrent, nonrhythmic, stereo-typed motor
movement or vocalization. Tics can be suppressed but not indefinitely. Stress
exacerbates tics, which diminish during sleep and when the person is
engaged in an absorbing activity. Common simple motor tics include blinking,
jerking the neck, shrugging the shoulders, grimacing and coughing. Common
simple vocal tics include clearing the throat, grunting, sniffing, snorting, and
barking.
-Tic disorders tend to run in families. Abnormal transmission of the
neurotransmitter dopamine is thought to play a part in tic disorders. Tic
disorders usually are treated with risperidone or olanzpine, which are atypical
antipsychotics. It is important for clients with tic disorders to get plenty of
rest and to manage stress because fatigue and stress increase symptoms.
• Tourette’s Disorder
-Tourette’s disorder involves multiple motor tics and one or more vocal tics,
which occur many times a day for more than 1 year. The complexity and
severity of the tics change over time, and the person experiences almost all
the possible tics described previously during his or her lifetime.
• Chronic Motor
-Chronic motor or vocal tic differs from tourette’s disorder in that either the
motor or the vocal tic is seen, but not both.
-Transient tic disorder may involve single or multiple vocal or motor tics, but
the occurrences last no longer than 12 months.
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Elimination Disorders
-Encopresis is the repeated passage of feces into inappropriate places such
as clothing or the floor by a child who is at least 4 years of age either
chronologically or developmentally.
-Enuresis is the repeated voiding of urine during the day or at night into
clothing or bed by a child at least 5 years of age either chronologically or
developmentally. Most often enuresis is involuntary; when intentional, it is
associated with a disruptive behavior disorder.
-Impairment associated with elimination disorders depends on the limitations
on a child’s social activities, effects on self-esteem, degree of social
ostracism by peers, and anger, punishment, and rejection on the part of
parents or caregivers.
-enuresis can be treated effectively with Imipramine (Tofranil) an
antidepressant with a side effect of urinary retention. Both elimination
disorders respond to behavioral approaches.
• Selective Mutism
- characterized by persistent failure to speak in social situations where
speaking is expected such as school
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-Children may communicate by gestures, nodding or shaking the head, or
occasionally one- syllable vocalizations in a voice different from their natural
voice.
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Del Rosario, Mikhail P.
Napala, Jennylen E.
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