EARLY INFANTILE AUTISM
INTRODUCTION
Autism is a complex developmental disability that typically occurs during the first three
years of life and is the result of a neurological disorder that affects the normal functioning
of the brain, impacting development in the areas of social interaction and communication
skills.
DEFINITION
Autism is a disorder of neural development that is characterized by impaired social
interaction and communication, and by restricted and repetitive behavior.
INCIDENCE
According to World Health Organization (WHO), around 1 in 100 children have autism
spectrum disorder (ASD). However, the prevalence of ASD in children varies by country
and age group: A 2021 study in India found that around 1 in 68 children have ASD, with
a higher prevalence in rural areas than in urban and tribal areas. The study also found that
boys are more likely to be affected than girls with a ratio of 3:1.
CAUSES
1. GENETIC FACTORS: Heredity
2. BIOCHEMICAL FACTORS: Alteration in the level of serotonin and growth hormone
has been associated with autistic disorders.
3. DEVELOPMENTAL FACTORS: Autism appears to result from developmental factors
that affect many or all functional brain systems and to disturb the timing of brain
development more than the final product.
4. MIRROR NEURON SYSTEM (MNS) THEORY: The MNS theory of autism
hypothesizes that distortion in the development of the MNS interferes with imitation and
leads to autism’s core features of social impairment and communication difficulties.
5. UNDER CONNECTIVITY THEORY: It hypothesizes that autism is marked by under
functioning high-level neural connections and synchronization along with an excess of
low-level processes.
6. SYNAPTIC DYSFUNCTION: It may lead to autism by disrupting some synaptic
pathways, such as those involved with cell adhesion
7. PERINATAL FACTORS: Maternal bleeding during gestation, use of medications during
pregnancy
8. PARENTAL FACTORS: Parental rejection, faulty communication pattern, broken
homes, parental stress etc.
9. ENVIRONMENTAL FACTORS:
a) Certain foods
b) Infectious diseases
c) Phenols used in plastic products
d) Pesticides
e) Alcohol
f) Smoking etc.
CLINICAL MANIFESTATION
SOCIAL DEVELOPMENT:
- Social impairment
- Lack of intuition about others
- Smile and look at others less often
- Less eye contact
- Poor social understanding
- Aggression and violence
- Destruction of property
COMMUNICATION:
- Lack of natural speech
- Delayed onset of babbling
- Unusual gestures
- Diminished responsiveness
- Poor words, and word combinations
- Echolalia
REPETITIVE BEHAVIOR:
a) Stereotypy is repetitive movement, such as hand flapping, making sounds or head
rolling
b) Compulsive behavior is intended and appears to follow rules, such as arranging objects
in stacks or lines.
c) Sameness is resistance to change; for example, insisting that the furniture not be moved
or refusing to be interrupted.
d) Ritualistic behavior involves an unvarying pattern of daily activities, such as an
unchanging menu or a dressing ritual.
e) Restricted behavior is limited in focus, interest, or activity, such as preoccupation with a
single television program, toy, or game.
f) Self-injury includes movements that injure or can injure the person, such as eye poking,
skin picking, hand biting, and head banging.
MANAGEMENT
1. Drug therapy such as Lithium, Resperidone etc.
2. Behavior therapy such as contingency management, positive reinforcement, self-care
skills, role modeling early in life can help children acquire self-care, social, and job skills.
3. Psychotherapy such as supportive psychotherapy, counselling
4. Structured teaching:- Special school education including vocational training and
residential treatment.
5. Cognitive therapy
6. Social skills therapy
7. Speech & language therapy
8. Applied behavior analysis (ABA):- Intensive ABA treatment has demonstrated
effectiveness in enhancing global functioning in preschool children and is well-
established for improving intellectual performance of young children.
9. Teacher training development programme to improve in skills of handling autistic
children.
CONCLUSION
Autism affects millions of people, but the exact cause is still unknown. Autism is believed
to be a genetic disorder and is caused by environmental factors. Autism affects an
individual’s developmental learning and behavior and education is key when finding the
treatment options which works best for each individual. Early diagnosis and treatment are
the ways in which an individual with autism could receive the help that is needed.
BIBLIOGRAPHY
Datta Parul, A Textbook of Pediatric Nursing, Jaypee Publication, Fourth
Edition, Page no: 584
Gupta Ghai O.P , Ghai Piyush V.K., Essential Pediatrics, 6th Edition
CBS Publishers and Distributors, Page No: 1001-1002
Kurian Somya, A Textbook of Pediatric Nursing , EMMESS Publication
Second Edition, Page no.: 448
Sharma Rimple, Essentials Of Pediatric Nursing, Jaypee Publication,
Third Edition, Page no: 530
Yadav Manoj, A Textbook of Child Health Nursing, S. Vikas &
Company (Medical Publishers), Revised Edition 2014, Page no.: 774
ONLINE REFERENCES
https://www.slideshare.net/slideshow/infantile-autism-seminarfinalpptx/254993648
https://www.slideshare.net/kavindyamj16/childhood-autism-59459949
ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)
INTRODUCTION
Attention deficit hyperactivity disorder (ADHD) also known as hyperkinetic disorder is
the most common childhood disorder affecting school- aged children. Affected children
commonly experience:
- Academic underachievement
- Problems with interpersonal relationships with family members and peers
- Low self- esteem
ADHD often co-occurs with other emotional, behavioral, language and learning disorders
DEFINITION
Attention – deficit hyperactive disorder is a childhood disorder characterized by persistent
pattern of inattention and hyperactive and impulsive behavior.
INCIDENCE
About 5% of children and about 2.5% of adults have ADHD
Primary school children in India- 11.32%
More prevalent in boys
RISK FACTORS
Genetics: siblings with ADHD, identical twins have greater chances to develop ADHD
Neurotransmitters: low levels of dopamine (causes hyperactivity and impulsivity) and
nor epinephrine (causes inattention)
Perinatal factors:
a. Maternal smoking and alcohol use during pregnancy
b. Pre-natal or post-natal exposure to lead
c. Birth complications
d. Premature birth
• Psycho-social factors:
a. Disorganized family pattern
b. Maternal mental disorder
c. Alcoholism in parents
d. Growing up in institutions ( foster homes)
TYPES
Inattentive type: symptoms of inattention
Hyperactive/ impulsive type: symptoms of hyperactive and impulsive behavior
Combined type: both inattention and hyperactivity
CLINICAL FEATURES
Poor attention span and distractibility:
a. Inability to complete the task from start to finish
b. Easily distracted
c. Can’t sustain attention
d. Careless mistakes
e. Lack of details in work
f. Have trouble organizing tasks
g. Loses belongings frequently
h. Difficulty following instructions
Hyperactivity and impulsivity:
a. Physical and/ or verbal over activity
b. Appear to be in constant motion and “ on the go” as if driven by a motor
c. Difficulty keeping their body still
d. Restless behavior
e. Talks excessively, interrupt others, not letting others talk
f. Can’t remain seated at school or workplace
g. Has difficulty waiting his or her turn or while waiting in line
CRITERIA FOR ADD OR ADHD DIAGNOSIS
Early onset: symptoms must have been present before age 7
Duration: a combination of symptoms must have been present for atleast 6 months
Settings: the symptoms must be present in 2 or more settings, such as home , school etc.
Impact: the symptoms must have a negative impact on the individuals school, family
and/ or social life
Developmental level: the symptoms are not due to the child’s normal development level
Alternative explanation: the symptoms are not caused by another physical, mental or
emotional disorder
MANAGEMENT
Medications
a. Stimulants to reduce hyperactivity and impulsivity and increase attention
(methylphenidate and amphetamines)
b. Non-stimulant medications: atomoxetine and bupropion
Behavior therapy
teaching the child time management and
organization of skills.
e.g. following structured routine
Special education
Social skills training
Effective parenting
a. Make clear schedules
b. Maintain routines
c. Make sure instructions are understood
d. Focus on child when talking to him/ her, avoid multitasking
e. Children with ADHD require more supervision than their peers
f. Maintain communication with the child’s teacher
g. Model calm behavior
h. Focus on effort and reward good behavior
CONCLUSION
ADHD is the most common neurobehavioral disorder of childhood, among the most
prevalent chronic health conditions affecting school- aged children and the most
extensively studied mental disorder of childhood.
BIBLIOGRAPHY
Datta Parul, A Textbook of Pediatric Nursing, Jaypee Publication, Fourth
Edition, Page no: 584
Gupta Ghai O.P , Ghai Piyush V.K., Essential Pediatrics, 6th Edition
CBS Publishers and Distributors, Page No: 1001-1002
Kurian Somya, A Textbook of Pediatric Nursing , EMMESS Publication
Second Edition, Page no.: 448
Sharma Rimple, Essentials Of Pediatric Nursing, Jaypee Publication,
Third Edition, Page no: 530
Yadav Manoj, A Textbook of Child Health Nursing, S. Vikas &
Company (Medical Publishers), Revised Edition 2014, Page no.: 774
ONLINE REFERENCES
https://www.slideshare.net/mamtabisht10/attention-deficit-hyperactivity-disorder-adhd-
235266029
https://www.slideshare.net/slideshow/attention-deficit-hyperactivity-disorder-
240434312/240434312
CHILDHOOD SCHIZOPHRENIA
DEFINITION
Childhood schizophrenia is a severe brain disorder in which children interpret reality
abnormally. Schizophrenia involves a range of problems with thinking (cognitive),
behavior or emotions.
ETIOLOGY
Unknown
Brain disorders
Genetics and environment
Problems with neurotransmitters
Difference in brain structure
RISK FACTORS
Family history of schizophrenia
Exposure to viruses, toxins or malnutrition while in the womb
Abnormal activation of the immune system
Older age of the father
Taking psychoactive drugs during teen years
ONSET
Symptoms start in the late teens to the mid- 30s
Early- onset schizophrenia occurs in children younger than age 17
Very early- onset schizophrenia in children younger than age 13
CLINICAL FEATURES
Early sign and symptoms:
- Language delays
- Late or unusual crawling
- Late walking
- Other abnormal motor behaviors
Symptoms in teenagers:
- Withdrawal from friends and family
- A drop in performance at school
- Trouble sleeping
- Irritability or depressed mood
- Lack of motivation
- Strange behavior
Later sign and symptoms:
- Hallucinations
- Delusions
- Disorganized thinking (speech)
- Disorganized or abnormal motor behavior
- Negative symptoms
DIAGNOSTIC MEASURES
Child’s medical and psychiatric history
Conduct a physical examination
Medical and psychological screenings
Review school records
Blood tests
Magnetic resonance imaging (MRI) or computed tomography (CT)
Electroencephalogram (EEG)
PSYCHOLOGICAL EVALUATION
Observe appearance and demeanor
Asking about thoughts, feelings and behavior patterns
Talking to child about any thoughts of self- harm or harming others
Evaluate the ability to think and function at an age- appropriate level
Assessing mood, anxiety and possible psychotic symptoms
DIAGNOSTIC CRITERIA
Hallucinations
Delusions
Disorganized speech
Disorganized behavior
Catatonic behavior which can range from a coma- like daze to bizarre, hyperactive
behavior
Negative symptoms which relate to lack of or reduced ability to function normally
MANAGEMENT
Medications
Individual and family therapy
Social and academic skills training
Hospitalization
Lifestyle and home remedies
CONCLUSION
Schizophrenia is a very serious illness, often people don’t realize how
serious this illness is. Schizophrenia is a relatively common chronic mental
illness which results in substantial disability and has a 10% risk of suicide.
Schizophrenia affects men and women equally, but it is usually diagnosed
earlier in men.
BIBLIOGRAPHY
Datta Parul, A Textbook of Pediatric Nursing, Jaypee Publication, Fourth
Edition, Page no: 584
Gupta Ghai O.P , Ghai Piyush V.K., Essential Pediatrics, 6th Edition
CBS Publishers and Distributors, Page No: 1001-1002
Kurian Somya, A Textbook of Pediatric Nursing , EMMESS Publication
Second Edition, Page no.: 448
Sharma Rimple, Essentials Of Pediatric Nursing, Jaypee Publication,
Third Edition, Page no: 530
Yadav Manoj, A Textbook of Child Health Nursing, S. Vikas &
Company (Medical Publishers), Revised Edition 2014, Page no.: 774
ONLINE REFRENCES
https://www.slideshare.net/slideshow/child-schizophrenia-and-
depression/33353221
https://www.slideshare.net/slideshoe/pediatric-schizophrenia-childhood-
onset-schizophrenia/214801588
CHILDHOOD DEPRESSION
DEFINITION
Being unable to enjoy activities that they once enjoyed, complaining about physical
ailments or may seem bored and have problems concentrating among other symptoms.
INCIDENCE
Each year depression affects 17 million people of all age groups, races, and economic
backgrounds.
1 in every 33 children may have depression
In teens, that number may be as high as 1 in 8
CAUSES
Lowered levels of neurotransmitters in the brain
Genetics
Significant life events
Stress
Chronic illness
TYPES
Major depression
Dysthymia
Bipolar disorder
CLINICAL FEATURES
Changes in appetite
Changes in sleep
Continuous feeling of sadness or hopelessness
Difficulty concentrating
Fatigue and low energy
Feelings of worthlessness or guilt
Impaired thinking or concentration
Increased sensitivity to rejection
Irritability or anger
Social withdrawl
DIAGNOSTIC MEASURES
History
Mental status examination
Laboratory tests
X- ray, scan or other imaging study
MANAGEMENT
Addressing any medical conditions
Supportive therapy
Psychotherapy
Interpersonal therapy
Cognitive behavioral therapy
Complementary therapies
Medications
CONCLUSION
Childhood depression is a chronic and disabling disorder. It needs expertise to diagnose
childhood depression due to myriad of symptoms. It should be identified and treated
because it has got a significant adverse affect on a youth’s emotional, social and cognitive
development.
BIBLIOGRAPHY
Datta Parul, A Textbook of Pediatric Nursing, Jaypee Publication, Fourth
Edition, Page no: 584
Gupta Ghai O.P , Ghai Piyush V.K., Essential Pediatrics, 6th Edition
CBS Publishers and Distributors, Page No: 1001-1002
Kurian Somya, A Textbook of Pediatric Nursing , EMMESS Publication
Second Edition, Page no.: 448
Sharma Rimple, Essentials Of Pediatric Nursing, Jaypee Publication,
Third Edition, Page no: 530
Yadav Manoj, A Textbook of Child Health Nursing, S. Vikas &
Company (Medical Publishers), Revised Edition 2014, Page no.: 774
ONLINE REFRENCES
https://www.slideshare.net/slideshow/child-schizophrenia-and-
depression/33353221
https://www.slideshare.net/slideshow/childhood-depression-247200687-247200687
