Download The Child with Cognitive, Sensory and Communication Impairment

The Child with Cognitive, Sensory and Communication Impairment
Julie Jones
Early Identification Intervention and Treatment
There is no one specific treatment.
however…..
•A lot can be done…
•The child will not “grow” out of a cognitive, sensory, or communication disorder.
Program for Children with Special Healthcare Needs
•High-Risk Infant Follow-Up
•Babies Can’t Wait
•Children's Medical Services
Nurses Role
•Assessment
•Education
•Prevention
•Referral
•Rehabilitation
The Child with A Learning Impairment
Learning Disabilities
Characterized by difficulty interacting with information:
•Reception
•Processing
•Expression
Etiology Unknown
A combination of organic, genetic and environmental factors may be involved.
Types of Learning Disabilities
•Dyslexia
•Dysgraphia
•Dyscalculia
•Right-left confusion
•Short attention span
Treatment for Learning Disorders
•Early identification, referral, assessment, evaluation, and intervention strategies that
include service provision are key to positive long term outcomes.
●Family education, educational strategies,
and interventions, individual counseling,
•Compensatory techniques are the goal.
Attention-Deficit Hyperactivity Disorder
Etiology Unknown
•A combination of organic, genetic and environmental factors may be involved.
•Support for a neurochemical etiology.
Treatment of ADHD
•Early identification, referral, assessment, evaluation, and intervention strategies that
include service provision are key to positive long term outcomes.
•Family education, behavior modification, educational interventions, individual
counseling, pharmacologically: stimulant drugs, (Ritalin and Adderall) non-stimulant
drugs (Strattera) and beta blockers (Tenex)
Children with learning disorders grow up to be adults with learning disorders.
Goal: identify areas of weakness and compensate for this.
Cognitive Impairment
•Term that refers to any type of mental difficulty or deficiency
•Synonymous with Mental Retardation (MR)
Mental Retardation
•Characterized by:
•Sub average intellectual functioning
•Functional impairment in 2 of 10 real-world adaptive skills
•Onset before 18 years.
Classification of Mental Retardation
Etiology of MR
•Familial
•Social
•Environmental
•Organic
Diagnosis and Tests
•Infancy: Bayley Scales of Infant Development or Mullen Scales of Early Learning
•School years: Wechsler Intelligence Scale for Children, Stanford-Binet Intelligence
Scale, et. al.
Disorders Associated with MR
•Down Syndrome
•Fragile X Syndrome
•Fetal Alcohol Syndrome
Down syndrome
Characteristics of Down syndrome
Assessment of the Ear Position
•Normal placement of the ears in relation to the face and scalp
•Associated congenital anomalies
Down syndrome
Treatments for Down syndrome
Characteristics of a Child with Fragile X syndrome
•hyper extensible joints
• long face with prominent jaw
• large, protruding ears
• large testes
Characteristics of __________________________________
Nursing Goal
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Unlocking the Mystery of Sensory Perceptual Problems
•A child learns about their world by using their sensory organs.
•Any impairment of the eyes, ears, speech, brain, muscles poses a threat to normal
development and growth.
Vision Impairment
•A common problem during childhood
•Prevalence of blindness in the pediatric population is 30-64 children per 100,000
Etiology of Vision Problems
•Genetics: Sickle Cell Disease, Tay-Sachs, albinism
•Perinatal infection: herpes, chlamydia, rubella, syphilis, toxoplasmosis
•Postnatal infection: meningitis
•Retinopathy of Prematurity
•Trauma
Assessment of Vision in Infancy
•Presence or absence of visual reflexes, pupillary constriction to light, red reflex and
blink reflex.
•Holding infant upright and rotating the infant slowly to get eyes open.
•2-4 mos. object fixation
•5-6 mos. tracking of an object
Care for the Visually Impaired Child during Hospitalization
•Reassurance of child and family
•Explanation of occurrences to the child
•Emphasize aspects and procedures that are felt or heard
•Orient child to the surroundings
•Provide safe environment
•Approach the child by always identifying yourself
•Encourage parents to room in
Hearing Impairment
Etiology of Hearing Loss
•Anatomical malformations of head, neck
•Low birth weight
•Perinatal infection: cytomegalovirus, rubella, herpes, syphilis, toxoplasmosis,
meningitis, maternal prenatal substance abuse, chronic ear infection, CP, Down
syndrome, ototoxic drugs
•High-risk neonates
Infant Hearing Assessment
•Newborn: acoustic blink reflex
•2 weeks of age: startle to loud noises
•3-4 mos: infant turns head to sound
•6-10 mos: infant responds to name and person’s voice and localize sounds
•10-12 mos: infant imitating simple words and sounds
Characteristics of Children with Hearing Deficits
•Use of gestures rather than words after age 15 months
•No intelligible speech by 24 months
•Monotone, unintelligible speech, laughter
•Head banging, foot stamping
•Yelling, screeching
•Avoidance of social interactions, confused
•Shy, withdrawn
Pathology & Treatments of Hearing Impairment
•Conductive or middle-ear hearing loss
•P.E. tubes, hearing aid
•Sensorineural, perceptive, nerve deafness
•Cochlear implants
•Mixed conductive-sensorineural hearing loss
Communication Impairment
Language Development
•So why can babies learn language so much more easily than adolescents or adults?
Early Indicators of Language Disorders
•No first words before second birthday
•Lack of progress in number of words
•No adjectives or adverbs
•Jargon continues after 18 mos.
•First sentences not spoken before 3rd birthday
•Plateaus
Etiology of Communication Impairment
•Mental Retardation
•Hearing impairment
•Central nervous system dysfunction
–Learning disabilities
–Traumatic Brain Injury (TBI)
•Autism
•Childhood Schizophrenia
•Organic problems
Speech Impairment
•Articulation
–Omission, distortion, substitution of sound
•Dysfluencies are rhythm disorders
–Repetitions of sounds, words, phrases
–Stuttering
•Voice disorders
–Deviations in pitch, monotone, loudness
Pervasive Developmental Disorders
An “Umbrella” Category
Etiology of Autism
•Unknown
•Diagnosis is based on observable behaviors
•Evidence supports multiple biologic causes
•Evidence supports a genetic basis
–Autosomal recessive pattern of inheritance
–Serotonin-transporter gene possible causative factor in autism
Diagnostic Criteria for Autism
• Social skills difference
•
•
Speech, language, & communication difference
Repeated behaviors & routines
Early Indicators of Autism
First Year
•Impairment in social interaction
•Lack of social smile
•Hypotonia
•Poor attention
•Unusual visual interests
Second Year
•Ignoring people
•Pref. for aloneness
•Empty gaze
•Lack of gestures
•Lack of emotional expression
Treatments for Autism
•No cure for Autism
•Therapeutic intervention in specialized area
•Highly structured intensive behavior modification programs
Objectives in Autism Treatment
•Promote positive reinforcement
•Increase social awareness of others
•Teach verbal communication skills
•Decrease unacceptable behaviors
Providing a structured routine for the child to follow is a key to the management of
Autism
Read vignette about David; reprinted from Laughing and Loving with Autism.
A Family Disease
Video Clip and Discussion