Sensory-Cognitive

1. Sensory-Cognitive

2. Common Sensory-Cognitive Disorders in Children • ADHD • Cerebral Palsy • Cognitive Impairment • Depression • Autistic Spectrum Disorders • Downs Syndrome • Visual and Hearing impairments

3. Developmental and Behavioral Disorders

4. Attention Deficit with Hyperactivity Disorder (ADHD) • Behavioral disorder affects 6% of US school age children • Ranges from mild to severe • Child has inattention, impulsiveness and hyperactivity developmentally inappropriate for the age w/o deficits in intelligence • Etiology is unknown • Suspect genetic component • Possible neurologic abnormality • Increased incidence in males

5. Symptoms Attention Deficit • unable to complete tasks effectively due to inattention or impulsivity Hyperactivity • excessive or exaggerated muscular activity • Often have an “engaging Personality” *symptoms must be present in at least 2 settings *must have been present before age 7

6. Assessment • Can not be made by diagnostic tests, imaging, etc. • Diagnosis is confirmed by comprehensive tests • Assessment usually begins in school • Need to have exact description “all or none” reaction to stimuli • Difficulty with right & left, today & tomorrow • Difficulty with common tasks • Awkward motor movements • Early identification is critical • Maladaptive behavior patterns • Exposed to negative feedback

7. Management **A Multiple approach is needed Environmental Manipulation • Stable learning environment with special instruction • Encourage parents to be fair but firm • Encourage parents to build self-esteem • Correct bad behavior immediately • Assign age appropriate chores with slow instructions

8. Management Medication (Stimulants) Ritalin, Cylert, Dexedrine, Adderal • Work by increasing dopamine and norepinephrine levels • Should be used in adjunct to environmental manipulation and therapy Side effects: • insomnia (give first thing in morning) • anorexia (monitor height & weight) Diet: nothing substantiated in research

9. Management Family support • Remind parents to be patient • Usually a “childhood condition” • Resolves by adolescence (increased attention span, ability to filter stimuli improves) • Long Term Planning is still necessary

10. Pervasive Developmental Disorders • Autism Spectrum Disorders • Autistic disorder • High Functioning Autism • PDD • Asperger’s Syndrome • Childhood Disintegrative Disorder • Rett’s disorder

11. Etiology • Unclear • Neurological origins • Genetic Factors • Possible Infectious, metabolic and immunologic causes • Possible environmental causes • Probably multifactoral • NO RESEARCH TO SUPPORT VACCINES AS A CAUSE!!!!!

12. Developmental disability • Symptoms are present before age three, in the developmental period • It causes delays in many different areas from infancy into adulthood • Symptoms range from mild to severe in individuals

13. Symptoms • Restrictive repetitive and stereotyped pattern of behavior, interests and activities • Hypo/hyper sensitivity • Qualitative Impairment in: • social interaction • symbolic or imaginative play • communication

14. Restrictive, Repetitive, Stereotyped Behavior • Abnormal intensity or focus • Inflexible and/or nonfunctional routine and rituals • Repetitive motor mannerisms (hand flap, whole body movements) • Preoccupation with parts of an object

15. Hyper/Hypo Sensitivity • Oral • Touch • Sounds • Photosensitivity Leads to Seeking/Avoiding Behavior

16. Impaired Social Interaction • Ranges from mild to marked impairment in nonverbal communication (eye-to-eye gaze, facial expressions, postures and gestures for communication) • Lack of peer relationships • Lack of social reciprocity

17. Lack of Symbolic Play • Prefers to line up toys in a row • May play with non-toy items • May not acknowledge toys with “faces” • Interested in parts of a toy • Lacks ability to pretend play

18. Impaired Communication • Ranges from minor impairment in either receptive or expressive language to lack of spoken language without alternative modes (gestures, mine) • In adequate speech, lack ability to initiate or sustain conversation • Repetitive or idiosyncratic language

19. Treatment Plan • No known cure • Wide variety of therapeutic options • Behavior management • ABA (Applied Behavior Analysis) • Speech-language therapy • OT • PT • Social Skills therapy • School and special education services • Early therapy - positive effect • Characteristics may improve with age • Can not generalize successful therapy to others

20. Recognize ‘Red Flags” and Refer! • Language is delayed • Child doesn’t respond to name • Child can not indicate wants • Lack of pointing, waving “bye-bye” • Intense tantrums • Has odd movement patterns • Child doesn’t play with toys in intended way • Child seems independent for age-gets things only for self, prefers to be alone • Spends time lining things up, putting in certain order • Poor eye contact • Has unusual attachment to objects • Does not seem interested in other children

21. Movement Disorders

22. Cerebral Palsy • A nonspecific term applied to disorders of early onset of impaired movement and posture secondary to abnormal muscle tone and coordination

23. Cerebral Palsy • May be accompanied by intellectual impairment and language deficits • The most common physical disability in children

24. Factors Associated with Cerebral Palsy Prenatal • Maternal diabetes • Rh or ABO incompatibility • Rubella in the first trimester • Genetics • Intrauterine ischemic event • Toxoplasmosis • Cytomegalovirus • Congenital brain abnormality

25. Perinatal Asphyxia Low birth weight Prematurity Precipitous delivery Pregnancy-induced hypertension Birth trauma Anoxia Prolonged labor Perinatal metabolic condition (diabetes) Intracranial hemorrhage Factors Associated with Cerebral Palsy (cont’d)

26. Factors Associated with Cerebral Palsy (cont’d) Postnatal • Infections • Trauma • Stroke • Poisoning

27. Clinical Manifestations • Delayed gross motor development • Abnormal motor performance • Alterations of muscle tone

28. Clinical Manifestations • Reflex abnormalities • Associated disabilities • cognitive impairment • seizures • impaired vision or hearing

29. Types of CP • Spastic • Dyskinetic • Ataxic • Mixed-type

30. Spastic • may involve one or both sides of body • hypertonicity with poor control of posture, balance, and coordinated movement • impaired fine and gross motor skills • active attempts at movement increase abnormal posture • Because of excessive energy expended, these children often need more calories.

31. Dyskinetic • abnormal involuntary movement • Athetosis: slow worm-like, writhing movements that involve extremities, trunk, neck, facial muscles and tongue • Poor oral tone, drooling, difficulty with speech

32. Ataxic • wide based gait • rapid repetitive movements poorly performed • disintegration of movement when child reaches for an object

33. Mixed • combination of spasticity and diskinetic

34. Diagnosis • Neurologist • MRI- identifies lesions and spinal cord pathology • ECG • CT head *early recognition important to maximize child’s abilities

35. Management GOAL: to promote optimal development Therapy on individual basis (PT, OT, Speech) home school hospital

36. Nursing Management • Establish locomotion, communication, self-help • Gain optimum development of motor function (braces, walkers, surgery to release contractures) • Pain management • Provide educational opportunities • Promote socialization

37. Mood Disorders

38. Depression • Childhood depression hard to detect • Kids can not always verbalize feelings • Feelings are usually acted out and overlooked Depression can be either Acute Chronic

39. Diagnosis Major Characteristics • Should have at least one of these present for 6 months: • Depressed mood and/or • Loss of interest or pleasure

40. Minor Characteristics • Must have five of these for 6 months: • Insomnia • Change in appetite or significant weight loss or gain • Psychomotor agitation • Feelings of worthlessness or inappropriate guild • Diminished concentration or indecisiveness • Recurrent thoughts of death or suicide

41. Symptoms • Solitary play • Withdrawn from previously enjoyed activities • Tearful • Clinging • Aggressive • Physiologic symptoms

42. Etiology • Biologic basis (neurotransmitter level) • Genetic basis • Interpersonal factors • Greater incidence in adolescents

43. Treatment • SSRI’s • TCA • Therapy • Individual • Group • Family

44. Cognitive Disorders

45. Cognitive Impairment • Classically defined as sub-average intellectual functioning, deficits in adaptive behavior and onset before 18 years of age • AKA Mental Retardation, “cognitive impairment” is preferred term

46. Definition IQ of < 85 and adaptive limitations in two or more of the following areas: • communication • self-care • home living • social skills • leisure • health & safety • self-direction • functional academics • community use • work

47. Causes of Cognitive Impairment • Hereditary origin • Early embryonic alterations • Early intrauterine or neonatal alterations • Acquired childhood conditions or diseases • Environmental problems and behavioral syndromes • Unknown causes

48. Assessment • Few physical indicators • Delay in Developmental Milestones • Nonresponsive to contact • Poor eye contact during feeding • Diminished spontaneous activity • Decreased alertness to voice or movement • Irritability • Slow feeding

49. Classification Based on IQ Test • Borderline • Mild • Moderate • Severe • Profound

50. Classification Borderline: 71-84 • Early milestones achieved • Noticed when school performance is monitored • Vocational skills adequate for competitive employment