Deficits in social interaction, communication; restricted and repetitive
behaviors
• Genetics
• Maternal Health Conditions: Conditions like obesity, diabetes, and
thyroid disorders during pregnancy may increase ASD risk.
• Birth Complications: Complications like low birth weight and
prematurity have been studied for potential links to ASD .
• Exposure to hazardous chemicals during pregnancy.
• Not responding to own name by 1 year (e.g., appears not to hear)
• Doesn’t show interest by pointing to objects or people by 14
months of age.
• Doesn’t play pretend games by 18 months of age.
• Avoids eye contact.
• Prefers to be alone.
• Delayed speech and language skills.
• Obsessive interests (e.g., gets stuck on an idea)
• Social
• Communication
• Behavior
• Atypical Antipsychotics
• Selective Serotonin Reuptake Inhibitors
(SSRIs)
• Mood Stabilizers / Anticonvulsants
• Implement safety precautions for self-injurious behaviors
such as headbanging.
• Provide support to parents.
• Initiate referrals to special programs as required.
• Determine the child’s routines, habits, preferences, and
maintain consistency as much as possible.
• Avoid placing demands on the child.
• Determine the specific ways in which the child
communicates and use this method.
• Referral to pediatric neurologist, developmental
pediatrician, or child psychiatrist.
• Routine health checkups.
• Speech Therapy: Helps with language and communication
• Impaired Social Interaction related to difficulty with interpersonal
communication, limited eye contact, and lack of empathy.
• Impaired Verbal Communication related to developmental delay,
limited vocabulary, or echolalia.
• Disturbed Sensory Perception related to hypersensitivity or
hyposensitivity to environmental stimuli.
Is characterized by inattentiveness over activity and
impulsiveness.
• Family history of ADHD (genetics)
• Brain development differences (especially in attention and impulse
control areas)
• Prenatal exposure to tobacco, alcohol, or drugs
• Premature birth or low birth weight
• Lead or toxin exposure
• Traumatic or stressful home environment
• History of neglect or abuse
• Unknown
• Short attention span / easily distracted
• Trouble focusing or completing tasks
• Forgetfulness and losing things
• Restlessness or constant fidgeting
• Excessive talking or interrupting others
• Difficulty staying seated or still
• Acting without thinking (impulsiveness)
• Difficulty waiting turns
• Frequent careless mistakes
• Struggles with organization and time management
• Gather info from parents/teachers
• Monitor and document behavior patterns
• Help administer rating scales
• Provide emotional support to family
• Educate about ADHD and treatment options
• Risk for injury related to impulsive behavior and poor judgment.
• Ineffective impulse control related to neurodevelopmental factors,
as evidenced by blurting out answers and acting without
considering consequences.
• Impaired social interaction related to hyperactivity and impulsivity,
as evidenced by difficulty taking turns and interrupting others.
1.Methylphenidate (Ritalin)
2.Transdermal patch (Daytrana)
3.Dextroamphetamine (Dexedrine)
4.Amphetamine (Adderall)
5.Pemoline (Cylert)
6.Lisdexamfetamine (Vyvanse)
• Antidepressants (SNRI)
1.Atomoxetine (Strattera)
2.Bupropion (Wellbutrin)
• Ensuring the child’s safety and that of others.
• Improved role performance.
• Simplifying instructions/directions.
• Structured daily routine.
• Client/Family education and support.
• Stimulant medications
• Non-stimulant medications
• Behavioral therapy
• Parent training to help manage behavior at home
• School interventions
• Lifestyle modifications
• A sudden rapid, recurrent, nonrhythmic, stereotyped motor
movement or vocalization. Can be suppressed but not indefinitely.
• Genetic predisposition
• Neurological factors
• Gender
• Age
• Environmental factors
• Prenatal factors
• Infections or autoimmune responses
The causes of tic disorders include genetic factors, neurological
abnormalities in the basal ganglia, environmental triggers such as
stress, anxiety, and fatigue, prenatal factors like exposure to harmful
substances or complications during pregnancy.
• Simple motor tics: Blinking, jerking the neck, shrugging the
shoulders, grimacing, and coughing.
• Simple vocal tics: Clearing the throat, grunting, sniffing, snorting,
and barking.
• Complex vocal tics: Repeating words or phrases out of context,
coprolalia, palilalia, echolalia.
• Complex motor tics: Facial gestures, jumping, or touching or
smelling
• History of tics: Onset, type (motor or vocal), frequency, and
duration
• Triggers: Stress, excitement, fatigue, anxiety
• Family history
• Observation
• Impact on daily life
• Emotional state
• Functional effects
• Assessment tools
• Risk for injury related to sudden, involuntary motor tics that may
result in self-harm or accidents.
• Impaired social interaction related to involuntary tics and peer
rejection, as evidenced by social withdrawal and difficulty forming
relationships.
• Chronic low self-esteem related to frequent tics and negative peer
feedback as evidenced by expressions of self-doubt and reluctance
to participate in activities.
• Atypical Antipsychotics:
1.Risperidone (Risperdol)
2.Aripiprazole (Abilify)
• Ensure safety
• Provide emotional support
• Promote self-esteem
• Identify and manage triggers
• Educate family and caregivers
• Monitor medications
• Coordinate with school
• Collaborate with healthcare team
• Medications
• Cognitive Behavioral Therapy (CBT)
• Follow-Up and Collaboration
Disruptive behavior disorders include problems with the
person’s ability to regulate their own emotions or behaviors.
They are characterized by persistent patterns of behavior that
involve anger, hostility, and/or aggression toward people and
property.
• Kleptomania is characterized by impulsive, repetitive
theft of items not needed by the person, either for
personal use or monetary gain.
• Pyromania is characterized by repeated, intentional firesetting. The person is fascinated about fire and feels
pleasure or relief of tension while setting and watching the
fires.
• Consist of an enduring pattern of uncooperative, defiant,
disobedient, and hostile behavior toward authority figures without
major antisocial violations.
• Involves repeated episodes of impulsive, aggressive, violent behavior
or verbal outbursts, usually lasting less than 30 minutes.
• Afterward, the individual may feel embarrassed and feel guilty for
their actions.
Conduct disorder is characterized by persistent behavior that
violates societal norms, rules, laws, and the rights of others.
Symptoms are clustered in four areas:
1.Aggression to people and animals
2.Destruction of property
3.Deceitfulness and theft
4.Serious violation of rules
Mild: The child has some conduct problems that cause
relatively minor harm to others. Examples include repeated
lying, truancy, minor shop-lifting, and staying out late without
permission.
Moderate: The number of conduct problems increases, as
does the amount of harm to others. Examples include
vandalism, conning others, running away from home, verbal
bullying and intimidation, drinking alcohol, and sexual
promiscuity.
Severe: The person has many conduct problems that cause
considerable harm to others. Examples include forced sex,
cruelty to animals, physical fights, cruelty to peers, use of
weapons, burglary, robbery, and violation of previous parole
and provation requirements.
• Genetic predisposition to behavioral or mood disorders.
• Inconsistent or harsh parenting styles.
• Family dysfunction, including substance abuse or mental health
issues.
• Exposure to trauma or adverse childhood experiences.
• Stressful family environments (e.g., divorce, poverty).
• Biological
factors
like
neurotransmitter
imbalances
or
temperament.
• Peer influence, including peer rejection or negative associations.
• Learning difficulties or attention-related issues.
• Typically a combination of genetic factors, environmental
influences, and family dynamics, including a family history of
mental health disorders, inconsistent or harsh parenting, exposure
to trauma or abuse, and biological factors such as
neurotransmitter imbalances or temperament that predispose the
child to defiant and oppositional behaviors.
• Frequent temper tantrums or angry outbursts.
• Argumentative and defiant behavior toward authority figures.
• Refusal to comply with rules or requests from adults.
• Deliberately annoying others or trying to upset them.
• Blaming others for personal mistakes or misbehaviors.
• Easily annoyed or touchy.
• Resentful or spiteful behavior, often seeking revenge.
• Persistent negative attitude or mood.
• Frequent conflicts with family members, teachers, or peers.
• Observe Behavior:
⚬ Watch how the child interacts with adults
⚬ Look for temper tantrums and signs of irritability.
• Family History:
⚬ Ask about family problems, like mental health issues or difficult
parenting styles.
⚬ Check if there are any signs of family conflict.
• Health History:
⚬ Ask about any other conditions like ADHD or learning
problems.
⚬ Review the child's health to rule out medical causes for the
behavior.
• Social Environment:
⚬ Ask if the child has experienced any trauma or abuse.
⚬ Check if the child has problems with friends or feels isolated.
• Use Tools:
⚬ Use questionnaires or scales to measure how bad the
behaviors are (like CBCL or Connors Rating Scale).
⚬ Get feedback from parents and teachers about the child’s
behavior in different settings.
• Consider Culture:
⚬ Understand the family’s culture and how it might affect the
child’s behavior or view of authority.
• Risk for Impaired Parenting related to inconsistent or harsh discipline
and inability to manage the child’s defiant behaviors, as evidenced by
parent-child conflict and ineffective discipline strategies.
• Chronic Low Self-Esteem related to negative behaviors leading to
rejection or punishment, as evidenced by frequent temper tantrums,
argumentative behavior, and withdrawal from social situations.
• Ineffective Coping related to an inability to manage anger or
frustration, as evidenced by frequent outbursts, defiant behavior, and
lack of conflict resolution skills.
• Stimulants (Methylphenidate and Amphetamines)
• Non-stimulants (Atomoxetine)
• Antidepressants (SSRIs like Fluoxetine or Sertraline)
• Antipsychotics (Risperidone or Aripiprazole)
• Mood Stabilizers (Lithium or Valproic Acid)
• Establish consistent discipline by setting clear rules and expectations.
• Promote effective communication by encouraging the child to express
their feelings in a healthy way.
• Collaborate with the family to educate and support parents in
managing defiant behaviors.
• Encourage engagement in behavioral therapy such as Cognitive
Behavioral Therapy (CBT) or Parent-Child Interaction Therapy (PCIT).
• Support the development of social skills.
• Provide support and education to the child and family about ODD.
• Medications for co-occurring conditions.
• Behavioral therapies.
Somatization is defined as the transference of mental
experiences and states into bodily symptoms. Somatic
symptom illnesses can be characterized as the presence
of physical symptoms that suggest a medical condition
without a demonstrable organic basis to account fully fo
them.
Somatic symptom disorder is characterized by one
or more physical symptoms that have no organic
basis. Individuals spend a lot of time and energy
focused on health concerns, often believe symptoms
to be indicative of serious illness, and experience
significant distress and anxiety about their health.
Functional neurological symptom disorder, formerly
called conversion reaction or disorder, involves
unexplained, usually sudden deficits in sensory or motor
function (e.g., blindness, paralysis).
Pain disorder has the primary physical symptom of pain,
which is generally unrelieved by analgesics and greatly
affected by psychological factors in terms of onset,
severity, exacerbation, and maintenance.
Illness anxiety disorder, formerly hypochondriasis, is
preoccupation with the fear that one has a serious
disease (disease conviction) or will get a serious disease
(disease phobia). It is thought that clients with this
disorder misinterpret bodily sensations or functions.
• Malingering - It is the intentional production of
false or grossly exaggerated physical or
psychological symptoms; it is motivated by
external incentives such as avoiding work,
evading criminal prosecution, obtaining financial
compensation, or obtaining drugs.
• Factitious disorder, imposed on self, occurs when
a person intentionally produces or feigns physical
or psychological symptoms solely to gain attention.
People with factitious disorder may even inflict
injury on themselves to receive attention. The
common term for factitious disorder imposed on
self is Munchausen syndrome.
• Family history of anxiety, depression, or somatic
symptoms
• Increased pain sensitivity
• Health anxiety or anxiety disorders
• Alexithymia: Difficulty identifying or expressing
emotions, leading to expression through physical
symptoms
• Abuse history, family modeling, cultural expression of
distress
• Low pain threshold or heightened bodily sensations
• History of chronic illness in childhood, which sensitizes
the individual to health concerns.
• Health-related anxiety or illness phobia.
• Cognitive
distortions:
Over-interpreting
bodily
sensations as dangerous or serious.
• Frequent medical visits with no clear diagnosis
• High sensitivity to body sensations
• Resistance to mental health referral
• Emotional distress (anxiety, depression)
• Functional impairment (work, social life)
• Ineffective coping
• Disturbed sensory perception related to stress
response
• Deficient Knowledge related to misinterpretation of
symptoms
• Anxiety related to fear of undiagnosed disease
• When the client requests a medication or treatment,
encourage the client to identify what precipitated their
complaint and deal with it in other ways.
• Observe and record the circumstances related to
complaints; talk about your observations with the client.
• Help the client identify and use nonchemical methods
of pain relief, such as relaxation.
• Acknowledge the complaint as the client’s perception
and then follow the previous approaches; do not argue
about the somatic complaints.
• Encourage the client to express feelings directly,
especially feelings with which the client is
uncomfortable (such as anger or resentment)
• Fluoxetine (prozac) - 20-60 mg/day, Monitor for rash, hives,
insomnia, headache, anxiety, drowsiness, nausea, loss of
appetite, avoid alcohol
• Paroxetine (Paxil) - 20-60 mg/day, Monitor nausea, loss of
appetite, dizziness, dry mouth, somnolence or insomnia,
sweating, sexual dysfunction; avoid alcohol.
• Sertraline (Zoloft) - 50 - 200 mg/day, Monitor for nausea, loss
of appetite, diarrhea, headache, insomnia, sexual dysfunction;
avoid alcohol.