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- Negative consequences of ADHD for Children with the condition
- CAUSES
PREVALENCEIt is estimated that OCD affects 1-2 percent of the population at any time, which is more prevalent than childhood diabetes. Up to 80 percent of cases develop before the age of 18. Untreated, OCD in children can be particularly devastating as it coincides with a crucial period of social and emotional development. Schoolwork, home life and friendships are seriously affected.TREATMENT The overall goal is to ensure that children and adolescents suffering from OCD can benefit from correct diagnosis and appropriate treatment. They may then go on to lead more confident lives now and minimize the risk of developing additional health complications in the future.
ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD) AND HYPERKINETIC DISORDER (HKD) ADHD and HKD are related conditions that differ in their severity and precise clinical definition. ADHD is defined by the American Psychiatric Association's Diagnostic and Statistical Manual (DSM IV). Whereas HKD is defined by the World Health Organization International Classification of Diseases (ICD-IQ) and has more stringent criteria for diagnosis. Both ADHD and HKD require that there is clear evidence of significant impairment in social, academic or occupational functioning. ADHD and HKD clinical features include -
Negative consequences of ADHD for Children with the conditionSCHOOL Poor classroom behaviour Poor academic performance school exclusion Special educational needs COGNITIVE Problems with verbal and non-verbal memory Problems with motivation Problems with productivity Lower intellectual capacity and learning difficulties LANGUAGE Excessive talking Problems with verbal reasoning Reduced ability for expressed emotion and ideas Impairments in speech PREVALENCE ADHD is the most common psychiatric disorder in children, with an estimated prevalence of 3-7% in school-aged children. The estimated prevalence of HKD the more severe form of ADHD, is around l% in school-aged children. (2004). CAUSESGenetics: strong suggestion to be hereditary.
DIET/TOXINS/ALLERGY
PSYCHOSOCIAL FACTORS
SUGGESTED READING ADHD. Diagnosis and Management. Janssen-Cilag Ltd 2003. UK American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM IV). 4TH Edition. Washington, DC. World Health Organization. International Classification of Diseases, 10th Edition. 1992. National Institute for Clinical Excellence - Young Minds Mental Health Charity - Royal College of Psychiatrists AUTISM
Autism is the name of the disorder used to describe a group of children that fall under this umbrella term, but who tend to be more impaired in their everyday functioning when looking at a range of abilities. PREVALENCE
Children with autism experience problems in 3 main areas Social interaction There are impairments in reciprocal social interactions i.e. lack of ability to take turns. They seem unable to 'read' their environment in the same way that most of us do. They have a difficulty with both verbal and non-verbal communication, often having no awareness of gesture or expression, so cannot read a person's emotion behind the spoken word. They also lack the capacity for empathy with others and do not understand that two people can feel very differently about the same things. Some parents report that their children were unresponsive to being kissed and cuddled as babies. The social smile may have appeared late and they are typically slow to distinguish between parents and strangers. This obviously makes these children extremely vulnerable so a high level of supervision is necessary at all times. Communication Both verbal and non-verbal language development is delayed. Not only do these children fail to develop normal, or sometimes any speech, but they also fail to communicate effectively by gesture, body movements or facial expression. They differ in this respect from children with developmental language disorders who often point to what they want, pull people towards things and make their wishes known in other non-verbal ways.
Behaviour The behaviour of autistic children is characterised by rigidity, stereotypes and inflexibility. The range of their behaviours is limited and they tend to impose rigidity and routine on a wide range of aspects of day-to-day functioning.
SUGGESTEED READING Re: Barker P (2004), Basic Child Psychiatry, 7th edition, Blackwell, Oxford PERVASIVE REFUSAL SYNDROME Pervasive Refusal Syndrome was first described by LASK 1991 when they reported four cases of girls between the ages of 9-14, who refused to walk, talk, eat, drink and look after themselves in any way. The children were clearly extremely ill both physically and psychologically and took many months to recover. What is the Condition? Whilst often presenting as an eating disorder, pervasive refusal syndrome is clearly far more complex and pervasive. Eating disorders are characterised by a morbid pre-occupation with weight and shape. However these children have far more pervasive symptoms and are not worried about weight or shape. Children present with elective mutism and mobility, anxiety states, phobias, depression, conversion disorder. Can present with physical elements
At the beginning of illness all physical elements are investigated and the results come back as normal. However the children can experience dramatic pain and it can be very anxious time for them and their families when not diagnosed at this time. Treatment When pervasive refusal syndrome has been diagnosed the child must be in a hospital setting where they feel safe and can stay for as long as necessary. Patience and sympathy are paramount. The ward milieu is valuable in that the other young people often help these children to make progress by sharing their sympathy. Groups are important for the children to feel involved although the children may not actively participate - those who have recovered often say that they have valued the concern and sharing. Individual timetable is very important staff acknowledging their physical elements with rest periods or time to express their pains therefore the child feels contained and safe. Individual therapy is best offered in a cognitive rather than psychodynamic framework. However what often seems to appear valuable is the opportunity to talk with a trusted member of staff on a regular and frequent basis. Parental counselling and family therapy are an essential component of the treatment. Medication is not used. Clearly a therapeutic alliance is required between the parents and the therapy team and this should be characterised by cooperation, cohesion, consistency and open and clear communication. EATING DISORDERS Food, weight and eating behaviour is a factor in many disorders and psychological problems, but in everyday conversation; the term “eating disorder” has come to mean anorexia, bulimia and binge eating, which you will find defined below. ANOREXIA NERVOSA: The relentless pursuit of thinness.
In addition, anorexia nervosa often includes depression, irritability, withdrawal, and peculiar behaviour such as compulsive rituals, strange eating habits, and division of foods into “good/safe” and “bad/dangerous” categories. The person may have a low tolerance for change and for new situations; they may fear growing up and assuming adult responsibilities, and an adult lifestyle. They may be over engaged with or dependent on parents or family members. They dieting may represent their avoidance of, or their ineffective attempts to cope with the demands of a new life stage such as adolescence. BULIMIA NERVOSA: The diet-binge-purge cycle.
Like anorexia, bulimia can kill. Even though bulimics put up a brave front, they are often depressed, lonely, ashamed, and empty inside. Their friends may describe them as competent and fun to be with, but underneath, where they hide their guilty secrets, they are hurting. Feeing unworthy, they have great difficulty talking about their feelings, which almost include anxiety, depression, self-doubt, and deeply buried anger. Their impulsive control may be a problem too; e.g. shoplifting, sexual adventurousness, alcohol and drug abuse, and other kinds of risk-taking behaviour. These people can act with little consideration of the consequences. BINGE EATING DISORDER.
People who have binge eating disorder do not regularly vomit, over-exercise, or abuse laxatives like bulimics do. They may be genetically predisposed to weigh more than the cultural ideal (which at present is exceedingly unrealistic), so they diet, make themselves hungry, and then binge in response to that hunger. Or they may eat for emotional reasons: to comfort themselves, avoid threatening situations, and numb emotional pain. Regardless of the reason, diet programs are not the answer. EATING DISORDER NOT OTHERWISE SPECIFIED (ED-NOS)
MEDICAL PROBLEMS If not stopped, starving, stuffing and purging can lead to irreversible physical damage and even death. Eating disorders can affect every cell, tissue and organ in their body. The following are a partial list of the medical dangers associated with anorexia nervosa, bulimia, and binge eating disorder.
Anal and bladder incontinence, urinary tract infections, vaginal prolapse, and other problems related to weak and damaged pelvic floor muscles. Some may be related to chronic constipation, commonly found in people with anorexia nervosa. Structural damage and atrophy of pelvic floor muscles can be caused by low estrogen levels, excessive exercise, and inadequate nutrition. Surgery may be necessary to repair the damage. If a binge eating disorder leads to obesity, this can include the following risks.
PSYCHOLOGICAL PROBLEMS.
CONDUCT DISORDER (INCLUDING OPPOSITIONAL-DEFIANT DISORDER) INTRODUCTION All children are defiant at times and it is a normal part of adolescence to do the opposite of what one is told. Oppositional-defiant disorder mainly applies to children whose functioning at home and at school is impaired by constant conflict with adults and other children. Conduct disorder mainly applies to adolescents whose behaviour goes to antisocial extremes; many are excluded from school or in trouble with the law.
DIAGNOSTIC FEATURES A pattern of repetitive, persistent and excessive antisocial, aggressive or defiant behaviour lasting six months or more.
DIFFERENTIAL DIAGNOSIS AND CO-EXISTING CONDITIONS Co-existent disorders are common and do not rule out the diagnosis; they are easily missed so should be carefully checked for:
Parenting problems are commonly associated and include a lack of positive joint activities with the child, insufficient praise, inconsistent discipline, harsh punishments, hostility, rejection or emotional abuse, sexual abuse, and poor monitoring of the whereabouts of older children. INVOLVING PATIENT AND FAMILY The child is likely to be temperamentally different from their siblings, and cannot easily control their actions. Antisocial behaviour is learned and can be corrected (unlearned). The long-term prognosis is not good without intervention (they do not ‘grow out of it’) but is good with appropriate management, especially parent behavioural management training Promote daily play and positive joint activities between parent and child for at least 10 minutes per day, despite both sides’ initial reluctance. Encourage praise and rewards for specific, agreed desired behaviours. If appropriate, monitor with a chart. Negotiate rewards with the child and change target behaviours every two to six weeks and rewards more often. Set clear house rules and give short specific commands about the desired behaviour, not prohibitions about undesired behaviour (e.g. 'Please walk slowly', rather that 'don’t run'). Provide consistent and calm consequences for misbehaviour. Many unwanted behaviours can be ignored, and will then stop (but may increase when this technique is first tried). Distracting the child from an unwanted behaviour is likely to be more effective than saying, 'Don’t do it'. If neither ignoring nor distraction is appropriate, ‘time out’ (to avoid the unwanted behaviour receiving positive reinforcement) may be effective. This can involve leaving the child alone to calm down or sending them to a quiet, boring ‘time out’ room (or other space in the house) for no more than one minute per year of age, and 10 minutes maximum. Avoid getting into arguments or explanations with the child, as this merely provides additional attention for the misbehaviour. Reorganize the child’s day to prevent trouble. Examples include asking a neighbour to look after the child while going to the supermarket, ensuring that activities are available for long car journeys, and arranging activities in separate rooms for siblings who are prone to fight. Monitor the whereabouts of teenagers. Telephone the parents of friends whom they say they are visiting. Liaise with school and suggest similar principles are applied. Parents should put pressure on the child’s school to look hard for specific learning difficulties such as dyslexia. MEDICATION Medication is of limited use in the disorder. Methylphenidate is effective for co-morbid hyperkinetic disorder and may reduce conduct problems in children with both problems LIAISON AND REFERRAL If problems are mainly or exclusively at school, parents should request that the school involves educational services, such as the Educational Psychology Service (for assessment of specific learning difficulty), the Educational Welfare Service (for attendance problems) or local behaviour support teams. Some schools employ school counsellors or specialized teachers who may be skilled in anger management training. Referral to a local Child and Adolescent Mental Health Service (CAMHS) should be considered for cases that fail to improve, where the behaviour is leading to major impairment, or where co-existing problems such as hyperkinetic disorder or autism spectrum disorder are suspected. For adolescents whose delinquent behaviour has involved them with the police, youth-offending teams can provide an intensive intervention package for the duration of the court’s involvement. This may include parenting groups for behavioural management training For preschool children, health visitors are trained to educate parents in behavioural management techniques. Local parent support agencies such as Sure Start may be able to provide more intensive input Social Services must be involved in cases of suspected abuse (of any sort), when a young person’s behaviour is beyond the control of parents, and with adopted children. They may not have the resources to help in more straightforward cases. RESOURCES FOR PATIENTS AND FAMILIES
SUGGESTED READING Kazdin A. Psychosocial treatments for conduct disorder in children. J Child Psychol Psychiatry 1997, 38: 161-178. Scott S, Spender Q, Doolan M et al. Multicentre controlled trial of parenting groups for child antisocial behaviour in clinical practice. Br Med J 2001, 323: 194-197. Woolfenden SR, Williams K, Peat J. Family and parenting interventions in children and adolescents with conduct disorder and delinquency aged 10-17 (Cochrane Review) In - The Cochrane Library, Issue 2, 2003. Oxford: Update Software. (AI) Eight trials were analysed.
Please help us improve the learning experience at Galaxy House. Your comments to the following questions will help and would be greatly appreciated. Do you feel that your learning needs were met? Yes No If not, why not? Was your mentor allocated prior to your arrival? Yes No Did all your Assessment meetings occur when scheduled? Yes No If not why not? Were you given the opportunity to access relevant spoke placements both in-house and externally? Yes No Where were they? How helpful were they? Were the staff friendly, approachable and helpful? Yes No Please comments Did you receive any teaching sessions from staff within? the service during your placement? Yes No Please give a brief description. What aspects of the placement did you enjoy? Why was this? Please Comments What did you least enjoy? Why was this? Please comments Do you have any suggestions for improving the learning experience at Galaxy House?
Thank you for your time and on completion please send this evaluation to the Practice Development Nurse, Galaxy House, Royal Manchester Children’s Hospital. Updated in May 2012 by Jane McEneaney -Acting Ward Manager Yüklə 233,88 Kb. Dostları ilə paylaş:
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