Children With Special Needs Lecture 5 The Special Child Children with physical and or mental deficits resulting from a long term chronic illness or disability Effects on physical well being psychological health and social growth development Special Health Care Needs Chronic illness Congenital disability Developmental Delay Disability Handicap Impairment Technology dependent child Child may see themselves differently or feel different due to their special needs Effects of Child on Family Looking at the family system adjustment is influenced by the functional burden of the family the problems needs of the child as compared to family resources their ability to cope helping the family within it s support system of family friends community maintain family centered care Coping Mechanisms Behaviors aimed at reducing tension Approach behaviors result in adjustment resolution of crisis seeks help support realistically plans for future expresses feelings Avoidance behaviors result in maladaptation to the crisis angry hostile to staff continually looks for new cures punishes self with guilt grieving loss of future with their child etc put their shoes on and imagine your life as thiers are their behaviors actually nasty towards you or is that they only way they can take out their anger Developmental Aspects Infancy parent child relationship Always needing a caregiver Toddler learning to walk talk Preschooler socialization identity School age achieve compete ADHD children will recognize their differences Adolescence independence self image Family Assessment Factors affecting level of adjustment Support systems ability to communicate Culturally can they tell you how it feels Middle eastern hard time when something happens to male child Perception of illness disability religious beliefs culture experiences some believe that this is what god wanted or that they are being punished reactions attitudes of others the way you and others react to seeing a child and family together available resources concurrent stresses financial tensions broader family tensions look at background of parents impacts guilt and how we treasure our guilt Alteration in Family Function Emotional reactions of denial guilt anger can impact family parenting relationships marriage other siblings tension the special child other siblings may love of hate this child denial is the most commonly used defense mechanism clarification normalization deny so that you don t have to embrace it if denial doesn t move on it can prevent you and the family from establishing and meeting goals for that child look broad and listen for cues actions speak louder then words Nursing Interventions Providing necessary support Accepting the family s emotional reactions Helping the family cope so that they can move past something developing partnerships in care connecting family with resources they need partnering so that we are all of the same page multidisciplinary Promoting normalization decision making planning care setting goals control expectations we want child to be as independent as possible adaptive coping normalization will normalize the entire family Rehabilitation and Habilitation Rehabilitation is relearning previously mastered tasks Learn to cope with what happened Habilitation is the mastering of new skills with growth development Used with children more then anything Children are on a continuum learning new skills and tasks Must begin immediately Must assess abilities disabilities identify supports and available resources then establish goals Goals of Care Fostering reality adjustment family education positive feedback establishing realistic future goals Promoting normal development by doing positive self imaging Promoting healthy sibling relationships and including siblings in the education Parents become the experts in care give them the necessary tools and resources Using our resources Community Considerations Case management parent professional partnerships of care Normalization special child within family community putting kids in schools Home care issues services needed including respite care come during night for about 10 hours so that parents don t have to perform any care School issues coordinate plans for child Looking To Our Government Public law 94 142 Education for all handicapped children act Facilitates the socialization in a regular school environment Public law 99 457 promotes early intervention programs for high risk children Take high risk families with emotional charging which can be linked to other long term problems for the siblings Terminal Illness Honest unbiased complete information is essential ethical principles therapeutic statements should be nonjudgmental feeling focused and supportive at all times do not give advice relate it to some divine master plan ignore the tough topics or EVER say I know how you feel what YOU would do doesn t matter be honest with child and answer on their cognitive level ADHD Long term behaviors of hyperactivity impulsiveness and inattention Frequently worsen in school etiology is uncertain affect 3 5 all school age children may be a deficit in neurotransmitters Clinical manifestations may be numerous or few mild or severe and will vary with the developmental level of the child Sometimes its missed and not diagnosed until you get to college Diagnostic Criteria Inattention inconsistent with development level for at least 6 months and or hyperactive impulsive behaviors Forgetful fidget interrupt Behaviors must be present before age 7 Must have social or academic impairments Psychological testing to identify intelligence achievement levels rule out psychiatric disorders Nursing Assessment Assess attention span listens when spoken to Follows through on instructions given Easily distracted Forgetful Organizational abilities Impulsive interrupts conversation Talks excessively when it is inappropriate Nursing Interventions Medications amphetamines Ritalin or Dexedrine help concentration but must be given early in day to not interfere with sleep can take 2 3 weeks before see effect peak effect in morning therefore teach important material at that time Anorexia blurred vision sleeplessness are major side effects but disappear usually in first 2 4 weeks Modify the environment decrease distractions look for appropriate classroom placement appropriate room mate for hospital room consistency between families teachers nurses the more routine the better Behavioral therapy positive reinforcement