Disorders of psychological development.pptx

Child health nursing

1. Disorders of psychological development f 8

2. SPECIFIC DEVELOPMENT DISORDERS OF SPEECH AND LANGUAGE : Disorders in which normal patterns of language acquistion are disturbed from the early stages of development . The conditions are not directly attribute to neurological or speech mechanism abnormality or mental retardation.

3. SPECIFIC DEVELOPMENTAL DISORDERS OF SCHOLASTIC SKILLS: SPECIFIC READING DISORDERS (DYSLEXIA): Slow acquistion of reading skills ,slow reading speed, impaired comprehension, word omissions and distortions and letter reversals . SPECIFIC SPELLING DISORDERS: Impairment in development of speeling skills in the absence of a history of specific reading disorders.

4. SPECIFIC DEVELOPMENTAL DISORDERS OF SCHOLASTIC SKILLS : SPECIFIC ARITHMETIC DISORDERS: Deficit basic computational skills of addition , subtraction, multiplication and division.

5. SPECIFIC DEVELOPMENTAL DISORDERS OF motor functions : SPECIFIC ARITHMETIC DISORDERS: Serious impairment in the development of motor co-ordination , which results in clumsiness in school work or play,

6. Pervasive developmental disorder: Group of disorders characterized by abnormalities in communication and social interaction and by restricted repetitive activities and interests .

7. CHILDHOOD AUTISM Autism is a complex neurobiological disorder that include impairments in social interaction, verbal and non verbal communication combined with restricted and repetitive behavior.

8. CHARACTERISTICS OF AUTISTIC DISORDER Inappropriate responses to environment Pronounced impairments in language,communication,and social interaction Repetitive interests and behavior Disordered thinking Difficulty understanding feelings of others Self injuries or other abnormal behavior

9. ETIOLOGY 1. GENETIC FACTORS : The higher concordance in monozygotic than dizygotic twins(36% vs. 0%) suggests a genetic factors. Siblings of autistic children show a prevalence of autistic disorder of 2% 2.BIOCHEMICAL FACTORS: At least 1/3 rd of patients with autistic disorder have elevated plasma serotonin 3.MEDICAL FACTORS : There is an elevated incidence of early developmental problems such as postnatal neurological infection(meningitis, encephalitis),congenital rubella and cytomegalovirus.

10. 4.PERINATAL FACTORS : During gestation, maternal bleeding after the first trimester and meconium in the amniotic fluid has been reported in the histories of autistic children. 5.PSYCHODYNAMIC $ PARENTING INFLUENCES $ SOCIAL ENVIRONMENT: Some of the specific causative factors proposed in these theories are parental rejection, child response to deviant parental personality characteristic, family breakup ,family stress etc.

11. 6.THEORY OF MIND IN AUTISM : Theory of mind describes the developmental process whereby the child comes to understand others minds or to anticipate what others may be thinking. 7. ELECTROPHYSIOLOGICAL CHANGES : Brain stem auditory evoked response (BAERs)of autistic children showed impairment in sensory modulation at brainstem level.

12. 8. NEUROANATOMICAL STUDIES : These studies have shown an enlargement of lateral ventricles and cerebellar degeneration.

13. CLINICAL FEATURES 1. BEHAVIOURAL CHARACTERISTICS ; Autistic aloofness, No or abnormal social play Gaze avoidance, Failure to develop empathy Dislike being touched or kissed, Anger or fear No separation anxiety on being left in an unfamiliar environment with strangers

14. CLINICAL FEATURES ( Conti..d ) 2. COMMUNICATION $ LANGUAGE : Gross deficits and deviances in language development No mode of communication such as babbling, facial expression, gestures Absence of imaginative activity such as play acting roles,fantasy characters of animals, lack of interest in imaginative stories

15. ACTIVITIES Marked restricted, repertoire of activities and interests . Stereotyped body movements, for example hand flicking . Marked distress over changes in trivial aspects of environment.

16. OTHER FEATURES More than half of autistic children have moderate to profound mental retardation. Autistic children are resistant to transition and change. May have a heightened pain threshold . Over responsive or under responsive to sensory stimuli. Other behavioral problems like hyperkinesis,aggression,temper tantrums, self injuries.

17. DIANGNOSIS No definitive diagnostic tool; usually diagnosed by age 3 after first ruling out other disorder that resemble autism(neurologic disorder, hearing loss, speech problems). Autism identifying methods by an autism specialist. Developmental screening to reveal behaviors suggestive of autism. After evaluation and testing.

18. TREATMENT 1. PHARMACOTHERAPHY ; Is valuable treatment for associated symptoms like aggression, temper tantrums, self injurious behavior. 2. BEHAVIOURAL METHODS ; Contingency management may control some of the abnormal behavior of autistic children. 3. SPECIAL SCHOOLING ; Most autistic children require special schooling and older adolescents many need vocational training.

19. TREATMENT (CONTI..D) 4. COUNSELING AND SUPPORTIVE THERAPHY; The family of an autistic child needs considerable help to cope with the child’s behavior, which is often distressing. 5. Home care to assist with the child’s physical or behavioral management at home. 6. Others ; Development of a regular routine, positive reinforcements to teach self care skills, speech therapy etc.

20. NURSING MANAGEMENT The following factors need to be considered in assessing an autistic child ( Lord and Rutter 1994) 1. Cognitive level 5. Psychosocial factor 2. Language ability 6. Associated medical condition 3. Communication skills, social skills, play repetitive behavior and other abnormal behavior. 4. Stage of social development in relation to mental age and stage of language development

21. ATYPICAL AUTISM A pervasive developmental disorder that differ from autism in terms of either age of onset or failure to fulfill diagnostic criteria,i.e disturbance in reciprocal social interaction, communication and restrictive stereotyped behavior .

22. RETT’S SYNDROME A condition of unknown cause, reported only in girls. It is characterized by apparently normal or near normal early development which is followed by partial or complete loss of acquired hand skills and of speech .

23. ASPERGER’S SYNDROME The condition is characterized by severe and sustained abnormalities of social behavior similar to those of childhood autism with stereotyped and repetitive activities and motor mannerisms, such as hand finger twisting or whole body movements.