NRNP 6665 Study Guide Forum Paper

NRNP 6665 Study Guide Forum Paper

NRNP 6665 Study Guide Forum Paper

NRNP 6665 Study Guide Forum

Autism Spectrum Disorder (ASD) is a neurological developmental disorder that presents with developmental disabilities, which lead to marked difficulties in social interactions, behavior, and communication.

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Signs and symptoms according to the DSM-5-TR

The DSM-V diagnostic criteria for ASD include the following signs and symptoms:

1. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following:
2. Deficits in social-emotional reciprocity.
3. Deficits in nonverbal communicative behaviors used for social interaction.
4. Deficits in developing, maintaining, and understanding relationships (Kodak & Bergmann, 2020).
5. Restricted, repetitive patterns of behavior, interests, or activities, as evidenced by at least two of the following:

Stereotyped or repetitive motor movements, use of objects, or speech.

1. Insistence on sameness, inflexible adherence to routines, ritualized patterns, or verbal nonverbal behavior.
2. Highly restricted, fixated interests that are abnormal in intensity or focus.
3. Hyper- or hypo-reactivity to sensory input or unusual interests in sensory aspects of the environment (Kodak & Bergmann, 2020).
4. The symptoms must be present in the early developmental period.
5. The symptoms should result in clinically significant impairment in social, occupational, or other important areas of current functioning.
6. The disturbances are not better explained by intellectual disability or global developmental delay (Kodak & Bergmann, 2020).

Differential diagnoses

ASD should be differentiated from:

• Attention deficit hyperactive disorder (ADHD)
• Intellectual/Learning disability
• Social Communication Disorder (SCD)
• Anxiety Disorder
• Attachment disorder
• Schizophrenia with childhood onset
• Psychosocial deprivation
• Sensory Processing Difficulties (SPD)
• Congenital deafness or severe hearing impairment

Incidence

• It is estimated that globally about 1 in 100 children have ASD
• Approximately 1 in 36 children have ASD in the U.S. (Speaks, 2021)
• Boys are four times more likely to be diagnosed with ASD than girls (Hodges et al., 2020).
• Autism affects all ethnic and socioeconomic groups.
• Minority groups tend to be diagnosed later and less often.

Development and course

• Autism can be reliably diagnosed as early as 2 years
• Most children are still being diagnosed after 4 years (Speaks, 2021).
• Girls with ASD are at more risk of progressing to more severe mental retardation
• Developmental regression, or loss of skills, like language and social interests, affects around 1 in 5 children who go on to be diagnosed with autism and typically occurs between 1-3 years (Hyman et al., 2020).

Prognosis

• ASD typically improves over time, as the child adapts to the environment.
• ASD is usually a lifelong disorder with a guarded prognosis.
• Two-thirds of patients with ASD remain severely handicapped and dependent.
• Children with an IQ > 70 usually have an improved prognosis and communication skills by ages 5-7 years (Hodges et al., 2020).

Considerations related to culture, gender, and age

• Clinicians managing children with ASD should be aware that suicide risk is higher in racial minorities and males.
• Suicide risk is also higher in children with peer victimization, behavior problems, lower education level, and lower socioeconomic status (Al-Beltagi, 2021).

Pharmacological treatments

• Antidepressants have inconsistent results in children with ASD and are ineffective in managing aggression.
• Risperidone (Risperdal) and aripiprazole (Abilify) are FDA-approved for irritation or aggression in ASD. However, they can cause extrapyramidal symptoms and excessive weight gain (Sanchack, 2020).
• Anxiolytics are used to manage anxiety.
• Melatonin improves sleep in ASD.

Non-pharmacological treatments

• Early non-pharmacological interventions usually comprise applied behavior analysis, which focuses on learning and reinforcing acceptable behaviors while putting out problematic behaviors (Kodak & Bergmann, 2020).
• Parent education and behavior interventions have been found effective in managing children with ASD.
• Almost all children with ASD require school-based assistance through an individualized education program (Sanchack, 2020).
• This usually comprises speech therapy, educational interventions, and occupational therapy.
• Cognitive behavior therapy (CBT) is effective in managing anxiety in school-aged children with ASD.
• Roughly two-thirds of preschool children with ASD usually undergo occupational therapy for motor, strength, and adaptive skills (Sanchack, 2020).

Diagnostics and labs

• There are no diagnostic tests to detect autism.
• Chromosomal microarray and fragile X testing are recommended for all children with ASD to predict prognosis.
• Chromosomal microarray reveals genetic abnormalities in about 42% of children with ASD. Fragile X testing is positive in less than 1% of patients with ASD, but it is essential for genetic counseling (Sanchack, 2020).
• Autistic children with motor delays should have creatine kinase and thyroid-stimulating hormone testing.
• Electroencephalography is indicated only to assess neurologic abnormalities and suspected seizures (Sanchack, 2020).

Comorbidities                          

• Most children with ASD have mood or attention disorders.
• Depression and suicide occur more often in patients with ASD, making screening important (Al-Beltagi, 2021).
• Sleeping difficulties are common and often worsen behavior issues and limit the effectiveness of behavior therapies.
• More than half of children with ASD have one or more chronic sleep problems.
• Anxiety disorders affect about 11-40 % of children and teens with ASD.
• Depression occurs in about 7% of children and 26% of adults with ASD (Speaks, 2021).
• Seizures affect 1 in 16 children with ASD, and the risk increases with intellectual disability.
• GI symptoms are common in children with ASD and often manifest as poor behavior or sleep disruption (Al-Beltagi, 2021).
• ADHD affects approximately 30-61% of children with autism (Speaks, 2021).

Legal and ethical considerations

• Many autistic patients without the mental capacity to provide informed consent have the mental capacity to decide whom they trust to assist.
• Informed consent should be obtained from parents or legal guardians when treating children with ASD (Manzini et al., 2021).
• Parents should be assured of the privacy and confidentiality of their child’s health information.

Pertinent patient education considerations

• Parents should be educated that they are their child’s advocate, a role that requires different skills based on the child’s needs.
• Parents should be informed of the risk of getting another child with autism.
• Parents who have a child with autism have a 2-18 percent chance of having a second child with the condition (Bradshaw et al., 2018).
• Patient education should also include available community resources for children and parents/caregivers with ASD.
• Parents and caregivers should be educated on how to take care of themselves since caring for a child with ASD can be physically and emotionally exhausting (Bradshaw et al., 2018).

References

Al-Beltagi, M. (2021). Autism medical comorbidities. World journal of clinical pediatrics, 10(3), 15–28. https://doi.org/10.5409/wjcp.v10.i3.15

Bradshaw, J., Bearss, K., McCracken, C., Smith, T., Johnson, C., Lecavalier, L., Swiezy, N., & Scahill, L. (2018). Parent Education for Young Children With Autism and Disruptive Behavior: Response to Active Control Treatment. Journal of clinical child and adolescent psychology: the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 47(sup1), S445–S455. https://doi.org/10.1080/15374416.2017.1381913

 Hodges, H., Fealko, C., & Soares, N. (2020). Autism spectrum disorder: definition, epidemiology, causes, and clinical evaluation. Translational pediatrics, 9(Suppl 1), S55–S65. https://doi.org/10.21037/tp.2019.09.09

Hyman, S. L., Levy, S. E., Myers, S. M., Kuo, D. Z., Apkon, S., Davidson, L. F., … & Bridgemohan, C. (2020). Identification, evaluation, and management of children with autism spectrum disorder. Pediatrics, 145(1). https://doi.org/10.1542/peds.2019-3447

Kodak, T., & Bergmann, S. (2020). Autism spectrum disorder: characteristics, associated behaviors, and early intervention. Pediatric Clinics, 67(3), 525-535.

Manzini, A., Jones, E. J. H., Charman, T., Elsabbagh, M., Johnson, M. H., & Singh, I. (2021). Ethical dimensions of translational developmental neuroscience research in autism. Journal of child psychology and psychiatry, and allied disciplines, 62(11), 1363–1373. https://doi.org/10.1111/jcpp.13494

Sanchack, K. E. (2020). Autism Spectrum Disorder: Updated Guidelines from the American Academy of Pediatrics. American Family Physician, 102(9), 629-631.

Speaks, A. (2021). Autism statistics and facts. Autism Speaks.

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Study Guide Forum

Abnormal brain development or damage at an early age can lead to neurodevelopmental disorders. Within this group of disorders, some are resolvable with appropriate and timely interventions, either pharmacological or nonpharmacological, while other disorders are chronic and need to be managed throughout the lifespan.

For this Assignment, you will develop a study guide for an assigned disorder and share it with your colleagues. In sum, these study guides will be a powerful tool in preparing for your certification exam.

Resources

Be sure to review the Learning Resources before completing this activity.

Click the weekly resources link to access the resources.

WEEKLY RESOURCES

Learning Resources

Required Readings

Hilt, R. J., & Nussbaum, A. M. (2016). DSM-5 pocket guide for child and adolescent mental health

Links to an external site.. American Psychiatric Association Publishing.

Chapter 12, “Developmental Milestones”Links to an external site.

Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Wiley Blackwell.

Chapter 51, “Autism Spectrum Disorder”

Chapter 55, “ADHD and Hyperkinetic Disorder”

Utah State University. (n.d.). Creating study guides

Links to an external site.. https://www.usu.edu/academic-support/test/creating_study_guidesLinks to an external site.

Walden University. (2020). Success strategies: Self-paced interactive tutorials

Links to an external site.. https://academicguides.waldenu.edu/academic-skills-center/skills/tutorials/success-strategiesLinks to an external site.

Zakhari, R. (2020). The psychiatric-mental health nurse practitioner certification review manual. Springer.

Chapter 13, “Child/Adolescent Neurodevelopmental Disorders”

Required Media

Dillon, K. (2019, March 23). DSM-5 neurodevelopmental disorders

Links to an external site.. [Video]. YouTube. https://www.youtube.com/watch?v=Jx4GuyX5SgcLinks to an external site.

The National Center for Learning Disabilities. (2013, February 20). What is ADHD?

Links to an external site. [Video]. YouTube. https://youtu.be/0Wz7LdLFJVMLinks to an external site.

Osmosis. (2017, October 17). Autism – causes, symptoms, diagnosis, treatment, pathology

Links to an external site. [Video]. YouTube. https://youtu.be/x2hWVgZ8J4A

Medication Review

Irritability in autism Attention-deficit/hyperactivity disorder
aripiprazole

risperidone

amphetamine IR, XR, and ER

dextroamphetamine

atomoxetine

clonidine hydrocholoride ER

Dexmethylphenidate IR and XR

guanfacine hydrocholride ER

lisdexamfetamine

methylphenidate

methylphenidate hydrocholoride IR and ER, transdermal

To Prepare

Your Instructor will assign you to a specific neurodevelopmental disorder from the DSM-5-TR.

Research your assigned disorder using the Walden Library. Then, develop an organizational scheme for the important information about the disorder.

The Assignment

Create a study guide for your assigned disorder. Your study guide should be in the form of an outline with references, and you should incorporate visual elements such as concept maps, charts, diagrams, images, color coding, mnemonics, and/or flashcards. Be creative! It should not be in the format of an APA paper. Your guide should be informed by the DSM-5-TR but also supported by at least three other scholarly resources.

Areas of importance you should address, but are not limited to, are:

Signs and symptoms according to the DSM-5-TR

Differential diagnoses

Incidence

Development and course

Prognosis

Considerations related to culture, gender, age

Pharmacological treatments, including any side effects

Nonpharmacological treatments

Diagnostics and labs

Comorbidities

Legal and ethical considerations

Pertinent patient education considerations

By Day 7 of Week 8

You will need to submit your Assignment to two places: the Week 8 Study Guide discussion forum as an attachment and the Week 8 Assignment submission link. Although no responses are required in the discussion forum, collegial discussion is welcome. You are encouraged to utilize your peers’ submitted guides on their assigned neurodevelopmental disorders for study.

Access the Study Guide Forum (or click the Next button).

submission information

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.

To submit your completed assignment, save your Assignment as WK8Assgn+last name+first initial.

Then, click on Start Assignment near the top of the page.

Next, click on Upload File and select Submit Assignment for review.