Boyd 8e

800

UNIT VII • Care of Children and Adolescents

Rios-Davis et al., 2023). In general, interactions with children can be guided by the following: • Set clear limits with clear consequences. Use few words and simplify instructions. • Establish and maintain a predictable environment with clear rules and regular routines for eating, sleep ing, and playing. • Promote attention by maintaining a calm environment with few stimuli. These children cannot filter out extraneous stimuli and react to all stimuli equally. • Establish eye contact before giving directions; ask the child to repeat what was heard. • Encourage the child to do homework in a quiet place. • Help the child work on one assignment at a time (reward with a break after each completion). Family treatment is nearly always a component of cognitive behavioral treatment approaches with the child. This may involve parent training that focuses on principles of behavior management, such as appropriate limit setting and use of reward systems, as well as revising expectations about the child’s behavior. School program ming often involves increasing structure in the child’s school day to offset the child’s tendency to act without forethought and to be easily distracted by extraneous stimuli. Specific remediation is required for the child with comorbid deficits in learning or language. Some children may require small self-contained classrooms. Complementary Therapies Although not found to be as effective as conventional treatment, yoga and meditation have shown small to moderate beneficial effects on the core symptoms of ADHD of attention, hyperactivity, and impulsivity. There is insufficient evidence to support use of acu puncture in children with ADHD. Evidence of the effectiveness of neurofeedback is mixed, with studies showing benefit pointing to “nonspecific” psychologi cal and behavioral effects versus impact of brain waves training. Newer emerging therapies under study include game-based digital therapeutics and trigeminal nerve stimulation (Caterfino et al., 2024; National Institutes of Health, National Center for Complementary and Integrative Health [NCCIH NIH], 2023; Russell & Arnold, 2023). Evaluation of Patient Outcomes Children may not notice any effects after taking med ication, but people in their environment do. Often, within 1 to 2 weeks of initiating therapy, children with ADHD become more attentive, less impulsive, and less active. Parents and teachers are often the first to notice

• Biologic Outcomes Distractibility Attention Impulsiveness

• Educational Outcomes

School performance Likelihood of early dropout Suspensions and expulsions

Promote

• Social Outcomes

• Interpersonal Outcomes

Social isolation Arrests Substance misuse

Family tension Success in peer relationships Acquisition of interpersonal skills

FIGURE 37.1 Long-term outcomes of optimal treatment for patients with attention-deficit hyperactivity disorder.

improvement. With time, academic achievement also may improve (Fig. 37.1). Continuum of Care Treatment of ADHD typically is conducted in outpatient settings. Optimal treatment is multimodal (i.e., includes several types of interventions), encompassing four main areas: individual treatment for the child, family treat ment, school accommodations, and medication. Parent training and social skills training also help diminish dis ruptive and defiant behavior. OTHER NEURODEVELOPMENTAL DISORDERS Other neurodevelopmental disorders are characterized by a narrower range of deficits. These include specific neurodevelopmental disorders generally classified as learning, communication, and motor skills disorders. This section focuses primarily on learning and commu nication disorders. In general, a learning disorder (a diagnostic term) or learning disability (a legal term) is defined as a discrepancy between actual achievement and expected achievement based on the individual’s age and intellectual ability. The definition varies depending on the source and state stat ute. Learning disorders are typically classified as verbal (e.g., reading, spelling) or nonverbal (e.g., mathematics). Reading disability, also called dyslexia , has been rec ognized for more than 100 years. It is defined as a signifi cantly lower score for mental age on standardized tests in reading that is not the result of low intelligence or inadequate schooling. This relatively common issue affects about 5% of school-aged children, with some studies reporting higher prevalence. In clinical samples, dyslexia affects male children more often than female children. This discrepancy can be explained by slower and variable processing speed and less inhibitory control in males than females. Approximately 40% of children

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