NRNP 6665 Week 7 Neurodevelopmental Disorders in Nursing Care
Introduction
Neurodevelopmental disorders are a group of conditions that begin in the developmental period, typically before school age, and are characterized by impairments in personal, social, academic, or occupational functioning. They include Autism Spectrum Disorder (ASD), Attention‑Deficit/Hyperactivity Disorder (ADHD), Intellectual Disability (ID), Communication Disorders, Specific Learning Disorders, and Motor Disorders.
For nurses, understanding these disorders is essential for assessment, care planning, family education, and long‑term management.
1. Classification of Neurodevelopmental Disorders
According to DSM‑5, major categories include:
Intellectual Disability (ID)
Communication Disorders (language disorder, speech sound disorder, childhood‑onset fluency disorder/stuttering, social communication disorder)
Autism Spectrum Disorder (ASD)
Attention‑Deficit/Hyperactivity Disorder (ADHD)
Specific Learning Disorder
Motor Disorders (developmental coordination disorder, stereotypic movement disorder, tic disorders including Tourette’s)
2. Pathophysiology and Etiology
Genetic factors: High heritability in ASD and ADHD.
Neurobiological basis: Abnormalities in brain structure and neurotransmitter systems (dopamine, serotonin, norepinephrine).
Environmental influences: Prenatal exposure to toxins, maternal infections, perinatal complications.
Epigenetics: Interaction between genes and environment.
3. Clinical Features
Intellectual Disability
Deficits in intellectual functioning (reasoning, problem‑solving).
Deficits in adaptive functioning (communication, social participation, independent living).
Autism Spectrum Disorder
Persistent deficits in social communication and interaction.
Restricted, repetitive patterns of behavior, interests, or activities.
Sensory sensitivities.
ADHD
Inattention, hyperactivity, impulsivity.
Symptoms present before age 12, across settings.
Communication Disorders
Delayed language development.
Difficulty with speech sounds, fluency, or social use of language.
Specific Learning Disorder
Difficulties in reading, writing, or mathematics despite normal intelligence.
Motor Disorders
Poor coordination, repetitive movements, or tics.
4. Nursing Assessment
History taking: Developmental milestones, family history, prenatal/perinatal events.
Behavioral observations: Social interactions, communication, attention span.
Screening tools:
Autism Diagnostic Observation Schedule (ADOS)
Conners’ Rating Scale for ADHD
Vineland Adaptive Behavior Scales for ID
Comorbidities: Anxiety, depression, epilepsy, learning disabilities.
Impact assessment: Academic performance, peer relationships, family stress.
5. Nursing Diagnoses
Impaired social interaction related to communication deficits.
Risk for injury related to impulsivity or poor coordination.
Deficient knowledge (family/patient) regarding disorder management.
Low self‑esteem related to repeated academic failures.
Ineffective coping related to chronic frustration.
6. Nursing Interventions
General Principles
Provide structured routines.
Use clear, simple communication.
Reinforce positive behaviors.
Collaborate with multidisciplinary teams (psychologists, speech therapists, occupational therapists).
Disorder‑Specific Interventions
ASD: Applied Behavior Analysis (ABA), social skills training, sensory integration therapy.
ADHD: Behavioral modification, organizational tools, medication monitoring.
ID: Individualized education plans, life skills training, family support.
Communication Disorders: Speech therapy, augmentative communication devices.
Learning Disorders: Specialized educational interventions, tutoring.
Motor Disorders: Physical therapy, occupational therapy, safety education.
7. Pharmacological Management
ADHD: Stimulants (methylphenidate, amphetamines), non‑stimulants (atomoxetine, guanfacine).
ASD: Antipsychotics (risperidone, aripiprazole) for irritability; SSRIs for anxiety.
Tic Disorders: Antipsychotics, alpha‑agonists.
Nursing role:
Monitor side effects.
Educate families about adherence and safe storage.
Assess therapeutic response regularly.
8. Psychosocial Considerations
Children with neurodevelopmental disorders often face stigma and bullying.
Families may experience stress, guilt, or conflict.
Nurses should provide emotional support, counseling referrals, and advocacy.
Encourage peer support groups for parents and adolescents.
9. Long‑Term Outcomes
Untreated disorders can lead to academic failure, unemployment, substance abuse, and poor social outcomes.
Early intervention improves prognosis.
Adults may struggle with independence, employment, and relationships.
Nurses should emphasize lifelong coping strategies and community resources.
10. Case Study Example
Patient: 7‑year‑old girl with delayed speech and poor social interaction.
Assessment: Limited vocabulary, avoids eye contact, repetitive hand movements.
Interventions: Speech therapy, structured play sessions, family education.
Outcome: Improved communication skills, better peer interaction, reduced family stress.
11. Summary of Nursing Priorities
Accurate assessment and diagnosis.
Individualized care planning.
Medication monitoring and education.
Behavioral and educational support.
Family involvement and empowerment.
Long‑term follow‑up and advocacy.
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