Psychiatric Nursing

Autism
Attention Deficit
Hyperactive Disorder
Mental Retardation
General Objectives:

• At the end of the presentation the

viewers will be able to understand
about autism, mental retardation and
ADHD.
Specific Objectives:

At end of presentation the viewers will

be able to:
• Define what is autism, ADHD and MR.
• Differentiate the mental disorders.
• To know the principles of the
disorders.
 What is autism?

• Autism is a complex developmental

disorder that appears in the first
3yrs. of life (through it may be
diagnosed later). It affects the brain’s
normal development of social and
communication skills.
 Alternative Names:
• Autistic disorder
• Infantile autism
• Autistic-like/ autistic- like tendencies
• Pervasive developmental delay
• Autism spectrum

Causes: “unknown”
Some combination of the following areas maybe affected in varying
degrees.
9. Impairment in communication
-echolalia
-confusion of personal pronouns
-verbal perseveration
-abnormal of prosody
-no meaningful speech in severe cases
2. Impairment in social interaction
- deficient non-verbal forms of social interaction
- withdrawn
-inability to appreciate other emotion
3. Sensory impairment
- hyperactive
- mouthing of object
- heightened or decrease sensitivity
- self-stimulating behaviors (rocks, body,
flaps hands, jumps, etc.)
- self-injurious behaviors (head banging,
pinches, hits self)
- resistance to change
4. Behavioral problems
- tantrums
- manipulative behavior
 Basic principle and
management technique:
• Be consistent
• Be firm; use clear rules
• Use appropriate rewards
• Choose priorities
• Use appropriate cues to assist
understanding and learning
 Signs and symptoms
• Resists normal teaching method
• Inappropriate laughing and giggling
• Echolalia
• Acts as if deaf
• No fear of real dangers
• Apparent insensitivity to pain
• Crying, tantrums, extreme distress for
discernible reason
• Spins object
• Not cuddly
• Sustained odd play
• Difficulty mixing with other children
• Resist change in routine
• No eye contact
• Stand-offish manner
• Uneven gross and fine motor skills-
may not to kick ball but can stack
blocks
• Inappropriate attachment to objects
• Indicate needs by gesture
• Marked physical over activity or
extreme passivity
 What causes ADHD?

• Exact cause is unknown

• There are implication of:
a. genetics/heredity
b. complication in pregnancy
• exposure to toxins
• Episodes of oxygen deprivation of
the fetus
• mothers who smoke during
 Problems of inattention
• They appear not to listen when spoken to
• Easily distracted
• Prone to make careless mistakes &
disorganized with school work
• Do not follow direction
• Do not obey
• Find it difficult & unpleasant to finish their
school works
• Losing their school books & assignments
• Have trouble sustaining attention in the
classroom
• Often forgetful in daily activities
Problems in hyperactivity
• Fidgeting, squirming around when seated
• Get up frequently
• May talk excessively
• Has difficulty playing quietly

Problems in impulsivity
• Often blurts out answers before questions have
been completed
• Has difficulty awaiting turn
• Often blurts or intrudes on others (butts into
conversation/games)
– Furthermore, children with ADHD can present a
challenge that puts significant stress on the
family, skills training for parents and siblings.
 Mental retardation

• An individual is considered to have

mental retardation based on the
following 3 criteria: intellectual
functioning level (IQ) is below 70-75;
significant limitations exist in two or
more adaptive skill areas, and the
condition is present from childhood
(defined as age 18 or less) (AAMR),
1992)
What are the adaptive skills essential for
daily functioning?
Adaptive skill areas are those daily living skills
needed to live, work and play in the community.
They include:
• Communication
• self-care
• Home living
• Leisure, health and safety
• Self direction
• Functional academics (reading, writing, basic
math)
• Community use and work
Adaptive skills are assessed in the person’s typical
environment across all aspects of an individual
life. A person with limits in intellectual functioning
who does not have limits in adaptive skill areas
may not be diagnosed as having mental
How does mental retardation
affect individuals?
The affects of MR vary considerably among people,
just as the range of abilities varies considerably
among people who do not have MR. About
87%will be mildly affected and will be only a little
slower than average in learning new information
and skills. As children, their MR is not readily
apparent and may not be identified until they
enter school. The remaining 13% of people with
MR, those with IQ under 50, will have serious
limitations in functioning. However, with early
intervention, a functional education and
appropriate supports as an adult, all can lead
satisfying lives in community.
How is MR diagnosed?
The AAMR process for diagnosing and classifying a
person as having MR contains 3 steps and
describes the system of supports a person
needs to overcome limits and adaptive skills.
The first step in diagnosis is to have a qualified
person give one and more standardized
intelligence tests, on an individual basis. The
second step is to describe the person’s strength
and weaknesses across 4 dimensions:
2. Intellectual and adaptive behavior skills
3. Psychological/ emotional considerations
4. Physical/health/etiological considerations
5. Environmental considerations
What are the causes of MR?
- MR can be caused by any condition
which impairs development of the
brain before birth, during birth, or in
the childhood years. Several hundred
causes have been discovered, but in
about one-third of the people
affected, the cause remains
unknown. The three major known
causes of MR are down syndrome,
fetal alcohol syndrome and fragile X.
The cause can be categorized
as follows:
• Genetic conditions- these result from abnormality
of genes inherited from parents, errors when
combine, or from other disorders of the genes
caused during pregnancy by infections,
overexposures to x-rays and other factors. More
than 500 genetic diseases are associated with
MR. some examples include PKU
(phenylketonuria), a single gene disorder also
referred to as and inborn error of metabolism
because it is cause by a defective enzyme. Down
syndrome is an example of a chromosomal
disorder. Chromosomal disorder happen
sporadically and are cause by too many or too
few chromosomes, or by a change in structure of
a chromosome. Fragile x syndrome is a single
gene disorder located on the x chromosome and
• Problems during pregnancy- use alcohol or
drugs by the pregnant mother can cause
MR. recent research has implicated
smoking in increasing the risk of MR. other
risks include malnutrition, certain
environmental contaminants, and illness of
the mother during pregnancy, such as
toxoplasmosis, cytomegalovirus, rubella
and syphilis. Pregnant women who are
infected with HIV may pass the virus to
their child, leading to future neurological
damage.
• Problems at birth- although any birth condition of
unusual stress may injure the infant’s brain, pre-
maturity and weight predict serious problems
more often than any other conditions.
• Problems after birth- childhood disease such as
whooping cough, chicken pox, measles, and
disease which may lead to meningitis and
encephalitis can damage the brain, as can
accidents such a blow to the head or near
drowning. Lead, mercury and other
environmental toxins can cause irreparable
damage to the brain and nervous system.
• Poverty and cultural deprivation- children in poor
families may become mentally retarded because
of malnutrition, disease-producing conditions,
inadequate medical care and environmental
health hazards. Also, youngsters, research
suggest that such under-stimulation can result in
irreversible damage and can serve as a cause of
Mild/moron IQ: 50/55-70 educable

Moderate/imb IQ: 35/40- trainable

ecile 50/55
Severe idiot IQ: 20/25-35- Needs close
40 supervision
profound Below 20-25 Needs
custodial care
 Principles of nursing care:

• Repetition
• Role modeling
• Restructuring the environment
 Focus of education:

• Reading
• Writing
• Basic arithmetic
Prepared by:
• Arcibal, Charmaine C.
• Arco, Lovely Mae M.
• Cantaros, Melody Jane A.
• Curay, Apple Joy D.
• Plaza, Michelle D.
BSN III-C

Submitted to:
Dr. Jane Borromeo Gallao, RN,MN
Reference:

• Psychiatric manual by: Mrs. Jane B.

Gallao, O.D.,R.N.,M.N.
• BCCTC handout