A 10-year-old Caucasian boy who lives with his parents and two siblings is seen in our community-based mental health clinic with a historical diagnosis of ASD treated with risperidone 0.5 mg for the past 2 years to manage symptoms of irritability and aggression. Melatonin has been found to be safe for children for short-term use, but the safety for long-term use remains unknown. Psychiatric assessment. The first author tends to start at 1 mg to 2 mg at bedtime and titrate up slowly by approximately 2 mg weekly, generally seeing a good response by 5 mg to 7.5 mg nightly. Kerns et al. Psychopharmacology . An increase in stereotyped/repetitive behaviors (which can resemble tics), obsessive-compulsive disorder (OCD)–like behaviors, and irritability are also possible risks after initiation of a stimulant. Chambers M. Interpersonal mental health nursing: Research issues and challenges. This is a dummy description. Reiersen, A. M. & Todd, R. D. (2008). 36. Best practice guidelines for the discontinuing treatment of children with anxiety disorders who are taking anti-depressants recommend a slow taper during a relatively stress-free period, following at least 12 months of symptom remission (Walter et al., 2020). Traditional and atypical presentations of anxiety in youth with autism spectrum disorder. ... Psychiatry & Mental Health Journals. Request permission to reuse content from this site. Impact Factor: 1.947. Before starting the medication, a personal and family history should be obtained of metabolic or cardiovascular disease, weight/body mass index, waist circumference, blood pressure, fasting plasma glucose, and fasting lipid profile. Antshel, K. M. & Russo, N. (2019). (2006). Best practices involve a collaborative child-and family-centered approach. They have observed increasing difficulties with avoidance behaviors, including school refusal, social isolation, and fears of being separated from his family. His parents wonder whether the increase in social demands of 5th grade, in addition to academic challenges, may be fueling some of his symptoms. ISSN: 1351-0126. 6, p. 505. What follows is a brief deidentified composite case based on the children the first author (L.B.) Behavioral and symptom measures help practitioners evaluate a child's baseline functioning and response to treatment. Alcohol and Alcoholism. The severity of impairment ranges from Level I (minimal support needed) to Level III (significant support needed) for each of two required diagnostic criteria: (1) persistent deficits in reciprocal communication/social interaction; and (2) restricted, repetitive patterns of behavior. For treating insomnia and disrupted sleep behaviors in children and adolescents with ASD, the American Academy of Neurology (AAN; Williams Buckley et al., 2020) recommend behavioral strategies as a first-line approach. (2014), which include monitoring blood pressure, fasting plasma glucose, and lipid profile at 12 weeks and annually (Riddle, 2019). The first author recommends obtaining a comprehensive metabolic panel at baseline because it includes liver function. The PMHNP would monitor outcomes, anticipating that after several months, the child would be less fearful of going to school and would be interacting more appropriately with his peers and falling asleep more easily. Pharmacotherapy of autism spectrum disorder: Results from the randomized BAART clinical trial. It’s a 60-credit hour program and takes 18-24 months to complete. (2004). As illustrated by the case composite of the 10-year-old boy with ASD and co-occurring ADHD with anxiety and behavioral and sleep problems, the approach of the PMHNP (first author) would be to collaborate with the child's therapist to reinforce the parents' preference to increase psychotherapy frequency to target his newly problematic avoidance-based behaviors and executive functioning skills. A mental health nurse is an expert in assessing, diagnosing and treating various psychiatric disorders. A., Spirito, A. For primary care nurse practitioners who wish to specialize in treating children with ASD, there are now a variety of online certificate programs available, including post-graduate PMHNP programs and autism certificate programs. Journals: ISSN: 13510126, 13652850: Coverage: 1994-2020: Scope: The Journal of Psychiatric and Mental Health Nursing is an international journal which publishes research and scholarly papers that advance the development of policy, practice, research and education in all aspects of mental health nursing. This is a dummy description. In clinical studies, non-stimulants are most useful for treating agitation/hyperactivity related to ADHD and are somewhat less effective for inattention and rarely used as monotherapy for ADHD. The first author finds that starting with the lowest dose (1 mg) of the standard formulation and titrating to a maximum of 5 mg nightly is well tolerated. The starting dose of long-acting methylphenidate (Concerta®) is 18 mg each morning and has a duration of effect of up to 12 hours.
2020 journal of psychiatric and mental health nursing