Child health nursing

1. DISORDERS OF PSYCHOLOGICAL DEVELOPMENT
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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 1/3rd 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. ACTIVITIE
S
 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.