Mental Health Nursing

1. WELCOME…

2. PERVASIVE
DEVELOPMENTAL
DISORDER
R.RUPPAMERC
Y
M.Sc NURSING
II YEAR

3. INTRODUCTION
pervasive developmental disorders (PDD) refers to a group of
disorders characterized by delays in the development of
socialization and communication skills.

4. CONTD…
 problems with using and understanding language
 Difficulty relating to people, objects, and events
 Unusual play with toys and other objects
 Difficulty with changes in routine or familiar surroundings, and
 repetitive body movements or behavior patterns.

5. CLASSIFICATION OF PDD
• Autistic disorder
• Rett’s disorder
• Childhood disintegrative disorder
• Asperger’s disorder(also called Asperger’s syndrome)
• Pervasive developmental disorder, not otherwise specified.

6. AUTISTIC DISORDER
Autism (ASD) is a developmental disorder affecting the areas of
the brain that affect communication and social skills. It is the
presence of abnormal and or impaired development that is
manifest before the age of 3 years, characterized by abnormalities
of social development, communication and a restriction of
behavior and interest.

7. HISTORY
• First described by Leo Kanner in 1943 as early infantile autism
“Auto” – children are “locked within themselves.”
• Lauretta Bender first used the term “childhood schizophrenia”
for childhood autism

8. EARLY SIGNS OF AUTISM
• Little or no eye contact
• Social withdrawal
• May have exceptional skills in some areas like music and
Maths
• Difficulty in learning language
• Inappropriate laughing
• Difficulty in expressing needs and can use gestures instead.

10. CAUSES
• Neurological implications – abnormalities in brain structure
• Less activity in the parietal areas
• Early developmental problems – postnatal neurological
infections
• Congenital rubella
• Genetic - Parents

11. CLINICAL FEATURES

12. MANAGEMENT
• Early intervention & special education programs may increase the
child’s capacity to learn, communicate, & relate to others.
• This approach also may reduce the severity & frequency of
disruptive behaviors.
• Although no drug has been shown to treat autistic disorder
successfully, stimulants such asmethylphenidate may reduce
inattentiveness, impulsivity, & overactivity in some children.
• SSRIs may be useful in managing compulsive behavior,
irritability, & withdrawal.
• Family counseling can help the family better understand the
disorder & assist them withcoping strategies & behavior
modificationtherapies.

13. NURSING MANAGEMENT
• Choose your words carefully when speaking to a verbal autistics
child.
• Offer emotional support & information to the To promote
communication, advice the parents to have close, face-to-face
contact with child.
• Teach the parents to maintain a regular, predictable daily routine,
with consistent times for waking up, dressing, eating, attending
school, & going to bed.
• Suggest that the parents use a picture board showing the activities
that will occur during the day to help the child make transitions
moreeasily.
• If the child’s routine must changed, instruct the parents to prepare
the child for the changes.

15. ASPERGER’S SYNDROME
• Asperger syndrome is a neurological-developmental disorder
which affects a person’s behavior, use of language and
communication and social interaction.
• A person suffering from this syndrome tends to have an obsessive
focus on one topic and is likely to perform the same behavior
repeatedly.
• It is five times more likely to affect boys than girls.

17. CAUSES
The exact cause of asperger is not known. It is largely an
inherited disorder.
Environmental factors also play an important role, such as
problems in pregnancy and birth, toxic exposures and prenatal
infections.
These environmental factors may increase the severity of the
underlying defect in genes.

18. CLINICAL FEATURES

19. MANAGEMENT
• Social skills training In groups or one-on-one sessions
• Speech-language therapy normal up-and-down pattern when
they speak rather than a flat tone
• Cognitive behavioral therapy It helps your child change their
way of thinking
• Parent education and training Help them deal with the
challenges of living.
• MEDICATIONS
• Selective serotonin reuptake inhibitors (SSRIs)
• Antipsychotic drugs
• Stimulant medicines

20. RETT’S DISORDER
Rett’s syndrome is a neurodevelopmental disorder occurring almost
exclusively in females that affects development after an initial 6
month period of normal development. The condition was first
described by an Australian Pediatrician Andreas Rett in 1966,hence it
is named.

21. pathophysiology
Decreased function of (MECP2 gene) which is located on the X –
chromosome.
Inadequate amount of proteins are produced
Structural abnormal forms
Abnormal gene expression

22. CLINICAL FEATURES
• Loss of purposeful movements of the hand such as touching,
grasping or reaching out
• Loss of speech
• Balance and coordination impairment leading to disability in
walking including losing the ability to walk in many cases
• Stereotyped hand movements
• Floppy hands and legs, excessive drooling
• Breathing problems
• Seizures, anxiety, social behavioral problems
• scoliosis
• Others

23. MANAGEMENT
No cure for rett’s syndrome.
Slow skill deterioration management:
1. Medications – carbamazepine,l-dopa
2. Surgery for heart defects
3. Stem cell therapy or gene therapy

24. Nursing management
• Physical needs
• Exercises
• Supplement feedings
• Nasogastric tube feeds
• Others

25. Childhood disintegrative disorder
Commonly called as Heller’s Syndrome. Boys>girls
Childhood Disintegrative Disorder is a rare condition, which is
characterized by late onset of development delays in language, social
function, and motor skills. Medical professionals and researchers
have not been able to find a cause of this disorder. Many doctors
consider CDD a low functioning form of autism, owing to many
underlying similarities to autism.

26. Clinical features
Significant loss of previously
acquired skills before a certain
age in at least two
 Ability to say words or
sentences
 Ability to understand verbal
and non-verbal
communication
 Social skills and self-care
skills
 Bowel and bladder control
 Play skills
Impairment occurs in at least
two of the following
• Social interaction
• Communication
• Repetitive and stereotyped
patterns of behaviors,
interests and activities

27. MANAGEMENT
No cure for this disorder. Treatment for this condition includes
Medications: there are no specific medications to treat CDD
However, to calm severe behavioral problems like aggression and
repetitive movement, there are many antipsychotic medications.
Behavioral Therapy: psychologists, speech therapists, physical
therapists and occupational therapists, even parents, teachers and
caregivers, commonly use this treatment.

28. Pervasive developmental disorder, not otherwise specified.
PDD-NOS is a neurological disorder that affects a child’s ability to
communicate, understand language, play, and relate to others.
Generally evident by age three.
This diagnosis is used when children do not meet the criteria for any
of the disorders listed under Pervasive Developmental Disorder,
Schizophrenia, Schizotypal Personality Disorder, or Avoidant
Personality Disorder.

29. CONTD…
Pervasive Developmental Disorder – Not Otherwise Specified (PDD-
NOS) refers to a group of disorders characterized by impairment
in the development of social interaction, verbal and non-verbal
communication, imaginative activity and a limited number of
interests and activities that tend to be repetitive.
A PDD-NOS diagnosis is given when a child does not fully meet the
criteria for Autism Spectrum Disorder (ASD), Asperger’s Syndrome,
Rett Syndrome or Childhood Disintegrative Disorder, but has several
of the characteristics.

30. CLINICAL FEATURES
1.Communication problems (using and understanding language)
2.Difficulty relating to people, objects, events
3.Unusual play with toys and other objects
4.Difficulty with changes in routine or familiar surroundings
5.Repetitive body movements, behavior, or play skills patterns
6.Unusual responses to sensory information. (ex: loud noise, light,
certain textures of food or fabrics)
7.Variations in abilities, intelligence, and behaviors
8.Difficulty with abstract concepts
9.Impaired social skills

31. MANAGEMENT
• Outline/planned and structured events.
• A good knowledge of the child’s strengths, weaknesses,
interaction preferences and early signs of distress.
• Social stories to help teach the child how to act in given situations.
• Use of visual cues to describe the routine. Visual cues are
especially useful when preparing for changes in routine. Giving
advance notice of change to routine and instructing parents and
teachers of appropriate strategies to implement in other
environments.
• Providing ideas and education around social story development.

32. NURSING MANAGEMENT
• Expanding abilities
• Social stories
• Behaviour management
• Structure and routine
• Sensory processing
• Pre-warning

33. THANK
YOU…….