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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