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23.1 Intellectual Disabilities

Intellectual disabilities are diagnosed in the developmental years but continue to affect individuals across the life span. Intellectual disabilities affect about 1 percent of the world’s population. There are many categories of intellectual disabilities that range from mild to severe. There are three areas of functioning affected by intellectual disabilities: conceptual, social, and practical. Causes can be related to genetics, maternal exposure to toxins while pregnant, and environmental factors. Treatments are based on the type of intellectual disability that has been diagnosed and any comorbidities that exist. Early intervention is a key component of all treatments.

23.2 Communication Disorders

Approximately one in ten American children have a communication disorder, one of a group of neurodevelopmental disorders that affect speech and language development (Psychology Today, 2022). The DSM-5 breaks communication disorders into five categories: language disorder, speech sound disorder, childhood-onset fluency disorder (stuttering), social communication disorder, and unspecified communication disorder (those that do not meet the DSM-5 criteria).

The type of intervention used to treat a communication disorder is based on the child’s age, the severity of the disorder and whether it is connected to another disorder. Interventions are intended to assist the child in developing their language skills and remove barriers to social participation (Law et al., 2017). Early intervention is considered to have the best outcomes and low-cost or free services may be available.

23.3 Autism Spectrum Disorder

According to the CDC, in 2020, approximately one in thirty-six children were identified as having autism spectrum disorder (ASD). ASD is a developmental disorder of the brain that causes impairment in behavior, communication, interaction with others, and learning. The American Academy of Pediatrics (2023) recommends screening children during their well-child visits at ages eighteen months and twenty-four months. This screening helps to identify developmental and behavioral challenges.

The nurse’s role is primarily education-based. Nurses can assist parents in finding community resources and services that support the care of the child with ASD. Current treatments for ASD seek to reduce symptoms that interfere with daily functioning and quality of life. ASD affects each person differently, meaning that people with ASD have unique strengths and challenges and thus different treatment needs. Treatment plans typically involve multiple professionals with interventions customized to the individual.

23.4 Attention-Deficit/Hyperactivity Disorder

Attention-deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders of childhood. It is usually diagnosed in childhood but often lasts into adulthood. ADHD affects approximately 9.8 percent of children aged thirteen to seventeen (CDC, 2022f). There is no single test to diagnose ADHD, and many other problems, such as anxiety, depression, sleep problems, and learning disorders, can have similar symptoms as ADHD. There are three types of ADHD, depending on which types of symptoms are strongest in the individual: inattentive, hyperactive-impulsive, and combined (CDC, 2021c). The main symptoms in ADHD, being impulsive and inattentive, can cause these children to have a higher risk for injuries.

Nurses should be aware of the different community resources available and refer parents to those entities; they should understand the medications prescribed to those with ADHD and therapies that have proven effective. Stimulants such as methylphenidate (Ritalin), dextroamphetamine (Dexedrine), and dextroamphetamine-amphetamine (Adderall) are considered first-line treatment because of rapid onset of action and a long record of safety and efficacy. Behavioral therapies are aimed at helping the child with ADHD decrease their disruptive behaviors and increase their positive behaviors (CDC, 2023e).

23.5 Specific Learning Disorders and Motor Disorders

Globally, learning disabilities occur in nearly 5 percent of all school-aged children. Learning disorders are caused by genetic and environmental factors (Dominguez & Carugno, 2023). Risk factors for developing learning disabilities include genetics, poverty, premature birth, alcohol exposure in utero, and traumatic brain injuries (Dominguez & Carugno, 2023). There are four commonly recognized learning disorders: dyslexia, dyscalculia, dysgraphia, and nonverbal learning disability (Dominguez & Carugno, 2023). The treatment plan is different for each child. It may include interventions, such as tutoring, an IEP, classroom accommodations, occupational or speech-language therapy, and possibly medication to address depression, anxiety, or behavioral issues (Mayo Clinic, 2023a). Motor disorders are a group of disorders that begin in the developmental years and cause delays in children reaching motor milestones. Symptoms include difficulty climbing stairs and tying shoes, making repetitive movements, or having physical or verbal tics.

23.6 Tic Disorder and Tourette Syndrome

Tourette syndrome (TS) and other tic disorders affect approximately 1 percent of school-aged children in the United States (Tourette Association of America, n.d.). Tics are sudden twitches, movements, or sounds that people do repeatedly with the inability to stop their body from doing these actions. In most cases, tics decrease during adolescence and early adulthood, and sometimes disappear entirely. The DSM-5 includes three types of tic disorders: Tourette syndrome, persistent motor or vocal tic disorder, and provisional tic disorder (CDC, 2023f).

There is no known cure for tic disorders, but there are medications and therapies available to reduce the tics. Some of the medications used to treat tics include antipsychotics, such as haloperidol (Haldol), risperidone (Risperdal), pimozide (Orap), and aripiprazole (Abilify). Botox (botulinum) injections administered to an affected muscle can reduce a motor or vocal tic. Comprehensive behavioral intervention for tics (CBIT) includes education, relaxation training, and behavioral rewards to the person with tics. CBIT has been shown to improve tics over the long-term (Frey & Malaty, 2022).

23.7 Conduct Disorder, Oppositional Defiant Disorder, and Disruptive Mood Dysregulation

Conduct disorder (CD) is diagnosed when a child shows an ongoing pattern of aggression toward others with serious violations of rules and social norms at home, at school, and with peers. Conduct disorder symptoms can begin as early as preschool but usually worsen when a child reaches middle school to age eighteen (American Psychiatric Association, 2021b). It is more common in males than females. Conduct disorder occurs in 2 to 10 percent of children in the United States (Cleveland Clinic, 2022a). The exact cause of conduct disorder is unknown. Multisystemic treatment (MST) is therapy that takes place over a three- to five-month period and uses a family-based approach (, 2023). This type of therapy provides support for both the child/adolescent and their parents. Medication is not a first-line treatment for conduct disorder. Research indicates the most effective treatment is behavior therapy training for parents where a therapist helps the parent learn effective ways to strengthen the parent-child relationship and respond to the child’s behavior. For school-age children and teens, a combination of behavior therapy training that includes the child, the family, and the school is most effective (American Academy of Child & Adolescent Psychiatry, 2018).


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