Pervasive Developmental Disorders of Childhood
Characterized by failure to acquire or loss of social skills and difficulty with language, children with pervasive developmental disorders develop lifelong problems related to social and occupational functioning.
Conditions under this classification are not reversible. Behavior therapy is the main treatment to improve communication skills and lessen behavior problems (e.g. self-harm). Self-care skills should be improved too and family members undergo supportive therapy and counseling.
Pervasive developmental disorders are divided into two groups: autism spectrum disorders (ASD) and other pervasive developmental disorders in children.
Autism Spectrum Disorders (ASD)
Autism Spectrum Disorders (ASD) occur in 17 per 10,000 children. These start before age 3 and are four to five times more common in boys. Etiologies include cerebral dysfunction, perinatal complications, genetic component, immunologic compatibility between mother and fetus, and smaller amygdala and hippocampus, fewer Purkinje cells in the cerebellum, and less circulating oxytocin.
- Autistic Disorder (severe form) is characterized by communication problems, significant inability to form social relationships, repetitive, purposeless behavior (e.g. spinning, self-injury, etc.), and subnormal intelligence in 25-75% of children. However, others have savant skills like exceptional memory or calculation skills.
- Asperger Disorder (mild form) is characterized by normal cognitive development with little or no language delay but with impaired conversational skills. Therefore, children with Asperger disorder have significant problems forming relationships. They also have repetitive behaviors and intense interest in obscure objects.
Other Pervasive Developmental Disorders
- Rett Disorder which is characterized by diminished social, verbal, and cognitive development after four years of normal functioning. This only occurs among girls. Stereotyped movements like hand-wringing is usually seen.
- Childhood disintegrative disorder involves diminished social, verbal, and cognitive function after two years of functioning. This also presents with mental retardation.
Here are nursing care tips for children with pervasive developmental disorders:
- Choose words carefully when speaking to verbal autistic child because they are likely to interpret words concretely.
- Advise parents to have close, face-to-face contact with child to promote communication.
- Maintain a regular and predictable daily routine to prevent outbursts. Prepare child for changes of routine.
- Educate parents on behaviors that signal tantrums such as increased hand flapping. Emphasize the importance of intervening and anticipating needs before a tantrum occurs.
- Advise patients on ways to provide a safe environment for the child (e.g. installing locks and gates).
- Educate family members on the medications (e.g. stimulants, selective serotonin reuptake inhibitors, lithium, etc.) the child is taking.
- Offer emotional support and information to parents.
- Arrange for family counseling to help parents better understand the disorder. This also assist them with their coping mechanisms.
- Provide referrals for early intervention, home care assistance, and support groups, as needed. Early intervention and special education programs increase child’s capacity to learn, communicate, and relate to others. This also reduce the severity and frequency of disruptive behaviors. Special schools for behavior modification is alright but educational mainstreaming is preferred.
Attention Deficit Hyperactive Disorder (ADHD) and Disruptive Behavior Disorders of Childhood
ADHD and disruptive behavior disorders of childhood are characterized by inappropriate behaviors which lead to problems in social relationships and school performance. Disruptive behavior disorders is further subdivided into two: conduct disorder and oppositional defiant disorder.
Thorough assessment is needed to differentiate it from other possible diagnosis like mood and anxiety disorders. Both diseases are common and usually seen in boys. There is no frank mental retardation.
Etiologies include genetic component, minor brain dysfunction, and substance abuse of parents. Contrary to popular opinion, there is basis for association between ADHD and improper diet or food allergy.
Attention Deficit Hyperactive Disorder (ADHD)
ADHD presents itself before age seven and is characterized by hyperactivity, impulsiveness, inattention, and carelessness. Children with ADHD have high propensity for accidents. They also have history of excessive crying and irregular sleep patterns in infancy. Upon reaching adolescence, hyperactivity is the first sign to disappear. However, most children show remission by adulthood.
Disruptive Behavior Disorders
- Conduct Disorder usually begins in ages 6-10 and would not show symptoms prior to age 10. This is best exemplified by child’s behavior that grossly violates social norms (e.g. animal torture, stealing, truancy). They have high risk for criminal behaviors, antisocial personality disorder, and substance abuse in adulthood.
- Oppositional Defiant Disorder usually begins at age 8 is characterized by defiant and negative behaviors (e.g. anger) that do not violate social norms. Children with this disorder are usually seen as argumentative and resentful especially towards authority figures. Most children develop conduct disorder in adulthood and cases of remission is high.
Here are nursing care tips for children with ADHD and conduct disorders:
- Establish a trusting relationship with child and family by conveying your acceptance.
- Provide clear behavioral guidelines, including consequences for disruptive and manipulative behavior.
- Talk to the child about making acceptable choices.
- Teach child on effective problem-solving skills, and have him or her demonstrate them in return.
- Identify abusive communication (e.g. threats, sarcasm, and disparaging comments). Encourage child to stop using them.
- Teach child on constructive methods of releasing negative feelings to express anger appropriately.
- Help the child accept responsibility for behavior rather than blaming others, becoming defensive, and wanting revenge.
- Use role-playing so he can practice ways of handling stress and gain skill and confidence in managing difficult situations.
- Instruct patients on how to deal with child’s demands. This might include learning how to reinforce appropriate behaviors. Ways to bond more strongly with the child should be encouraged.
Major Depression (Unipolar Depression)
It is a syndrome of persistently sad or irritable mood accompanied by disturbance in sleepand appetite, lethargy, and inability to express pleasure. The depressed episode should last at least two weeks for it to be clinically significant. Depressed children and adolescents are typically sad and lose interest in activities that used to please them. They are also particularly at increased risk for substance abuse and suicidal behavior. Unlike from depression in adults, psychotic symptoms are rare in children. Instead, they are more likely to experience anxiety symptoms (e.g. reluctance to meet people) and physical symptoms (e.g. aches and pains).
Here are nursing care tips for children with major depression:
- Structure and maintain a safe environment.
- Monitor closely for dangerous or self-destructive behaviors.
- Develop an agreement or contract with child about seeking a staff whenever he feels desperate or suicidal.
- Teach child to talk things out rather than act things out.
- Help child talk about problems and stressors. Encourage child to express feelings openly.
- Provide physical outlets for energy and aggression release (e.g. sports, music, art, etc.)
- Help identify supportive people and help child learn ways to talk to these people about his feelings and needs.
References
- Brady, N. (2006). Straight A’s in Psychiatric and Mental Health Nursing: A Review Series. Ambler, PA: Lippincott Williams & Wilkins.
- Fadem, B. (2011). Board Review Series: Behavioral Sciences. (5th ed.). PA: Lippincott Williams & Wilkins.
