A checklist of routine daily activities (e.g., chores, homework completion) can often help parents/guardians identify how well the child is able to attend and control impulsive/hyperactive behaviors, and it is valuable information for the clinician to understand where impairments lie to better target symptoms. Prevalence of co-occurring mental health diagnoses in the autism population: A systematic review and meta-analysis. The only FDA-approved medications for ASD–related irritability and aggression are risperidone and aripiprazole for children aged 5 (risperidone) and 6 (aripiprazole) to 17. Weight gain and metabolic consequences of risperidone in young children with autism spectrum disorder. & Rockhill, C. (2020). In children with ADHD–inattentive type, the differential is more challenging. [Journal of Psychosocial Nursing and Mental Health Services, 58(12), 7–12. & Bragg, J. E. Jr. . The first author uses the National Institute for Children's Health Quality (n.d.) Vanderbilt Assessment Scale in clinical practice for assessing children with ASD and co-occurring ADHD because it allows for parent and teacher ratings, with shorter versions for monitoring ongoing symptoms. & Brookman-Frazee, L. (2020). JAPNA publishes both clinical and research articles relevant to psychiatric nursing. Address correspondence to Karan Kverno, PhD, PMHNP-BC, PMHCNS-BC, Assistant Professor, Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore, MD 21205; email: This correlation highlights the importance of working with children with ASD and their families to find ways to manage everyday stressors, to use consistent sleep hygiene practices, and reinforce positive social interactions. (2013). The prevalence of anxiety disorders or symptoms among young children with ASD is higher than in children with other neurodevelopmental disorders (Vasa et al., 2020). All rights reserved. The first author's clinical approach is to start with a long-acting methylphenidate, particularly if the child is struggling with aggression, which can be intensified when treated with amphetamine-based stimulants. [email protected]
Connecting parents/guardians with resources (e.g., Autism Speaks, 2018; Neupane, 2020; The Reach Institute, n.d.), including respite care, can be helpful in improving their ability to successfully care for their child and cope with the demands. (2014). This is a dummy description. American Association of Nurse Practitioners. The first author recommends obtaining a comprehensive metabolic panel at baseline because it includes liver function. All papers must have clear implications for mental health nursing either solely or part of multidisciplinary practice. The Educational Paths to Becoming a Psychiatric or Mental Health Nurse Associate Degree in Nursing (ADN) The ADN is the most common degree among RNs. The only FDA–approved medication for treatment of an anxiety disorder (e.g., GAD) in children and adolescents is the serotonin-norepinephrine reuptake inhibitor (SNRI), duloxetine, yet it is considered a secondary treatment due to having more adverse effects than SSRIs (Riddle, 2019; Walter et al., 2020). Methylphenidate has been found to be effective in improving attention and reducing impulsivity and hyperactivity and is well-tolerated for treatment of comorbid ADHD among children and adolescents with ASD (Ventura et al., 2020). Whereas children with ASD may display stereotypic and repetitive behaviors, children with ASD who also display general hyperactivity and impulsivity are more likely to have co-occurring ADHD (APA, 2013; Shephard et al., 2019). The motor and behavioral symptoms more clearly differentiate ASD and ADHD. Reiersen, A. M. & Todd, R. D. (2008). ... Psychiatry & Mental Health Journals. The newly drafted guidelines published by the Academy of Child and Adolescent Psychiatry (Walter et al., 2020) recommend, for children and adolescents ages 6 to 18 with diagnosed social anxiety, GAD, separation anxiety, specific phobia, or panic disorder, that CBT be offered as the first-line treatment for mild to moderate severity. In the experience of the first author, sertraline or escitalopram may be good choices due to having a short metabolic half-life and the ability to discontinue or taper the medication more rapidly in case of adverse side effects. What follows is a brief deidentified composite case based on the children the first author (L.B.) (n.d.). Autism spectrum disorders and ADHD: Overlapping phenomenology, diagnostic issues, and treatment considerations. Behavioral activation/agitation that includes increased motor or mental restlessness, insomnia, impulsiveness, talkativeness, disinhibited behavior, and aggression can occur with SSRI treatment, so starting the dose low and increasing the dose gradually to the lowest effective dose over several months is recommended. For children with greater anxiety severity and related impairment, they recommend combination treatment (CBT and selective serotonin reuptake inhibitor [SSRI]) be offered preferentially over CBT alone or a SSRI monotherapy alone due to evidence that the combination is a more effective short-term treatment for anxiety in children and adolescents than either treatment alone (Walter et al., 2020). ], Exploring psychotherapeutic issues and agents in clinical practice. To consent to treatment, the child and family need to understand the diagnoses, the purpose, risks and benefits of the proposed treatments, the risks and benefits of alternative treatments, and the risks and benefits of declining treatment (Riddle, 2019; Walter et al., 2020). Wolraich, M. L., Hagan, J. F. Jr.. , Allan, C., Chan, E., Davison, D., Earls, M., Evans, S. W., Flinn, S. K., Froehlich, T., Frost, J., Holbrook, J. R., Lehmann, C. U., Lessin, H. R., Okechukwu, K., Pierce, K. L., Winner, J. D. & Zurhellen, W.Subcommittee on Children and Adolescents with ADHD. 26, No. Lei, J., Sukhodolsky, D. G., Abdullahi, S. M., Braconnier, M. L. & Ventola, P. (2017). 36. Parents/guardians and teachers can help by noting changes in behavior once the treatment begins. For children, stimulant medications (methylphenidate or amphetamine compounds) are the first line treatments for ADHD (Wolraich et al., 2019). Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Abbreviation: J Psychiatr Ment Health Nurs. Substance Abuse and Mental Health Services Administration. Best practices involve a collaborative child-and family-centered approach. COVID-19 Discipline-Specific Online Teaching Resources, Peer Review & Editorial Office Management, The Editor's Role: Development & Innovation, People In Research: Interviews & Inspiration. Psychiatric Nursing. Psychiatric comorbidity is common in children with ASD. The Journal of Korean Academy of Psychiatric and Mental Health Nursing is focused on innovations in practice that are based on development, evaluation and research. COVID‐19 under the SARS Cloud: Mental Health Nursing during the Pandemic in Hong Kong . Autism spectrum disorder: The parental experience. Students can choose between on-campus and online programs. Williams, N. (2014). The journal is essentially a means of communication between professionals that are, mainly in nursing but it also attracts other mental health … 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. Vasa, R. A., Keefer, A., McDonald, R. G., Hunsche, M. C. & Kerns, C. M. (2020). A brief measure for assessing generalized anxiety disorder: The GAD-7. The staff of the Journal of Psychosocial Nursing and Mental Health Services and the staff of AKH Inc., Advancing Knowledge in Healthcare have disclosed no relevant financial relationships. The recommended dosage range is 2 mg to 10 mg daily. Lai, M. C., Kassee, C., Besney, R., Bonato, S., Hull, L., Mandy, W., Szatmari, P. & Ameis, S. H. (2019). Therapeutic interventions for the social deficits of ASD include social skills training and behavioral therapy. Speech therapy is frequently recommended for speech and communication deficiencies. Parents/guardians can be asked to monitor sleep behaviors (Shapiro, 1998). There are many scales available for screening and monitoring of symptoms in children related to ASD, ADHD, anxiety, sleep, and behavioral dysregulation. 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. Journal of Korean Academy of Psychiatric and Mental Health Nursing (JKPMHN) disseminates original, peer-reviewed research that is of interest to psychiatric and mental health care nurses. 14, Issue. Would you like to change to the United States site? PMHNPs are called on to treat problems that impair functioning, negatively impact relationships, and put the child or others at risk for harm. Download Product Flyer is to download PDF in new tab. Common adverse effects of risperidone and aripiprazole include sedation and anticholinergic effects (e.g., dry mouth, constipation). Journal of Hospice and Palliative Nursing, November 25, 2020 . A prolactin level should be obtained if symptomatic, and if hyper-prolactinemia is present, a decrease in dosage should be considered. A., Spirito, A. & Vitiello, B. The clinician is required to document the target symptoms and laboratory results, as well as the score on the Abnormal Involuntary Movement Scale. (For additional ADHD measurement tools, see Limandri ). The focus of treatment for children with ASD, as depicted in the case composite, is to improve social relationships and function, with safety taken into consideration. Ms. Beauvois is Nurse Practitioner, The Johns Hopkins Children's Mental Health Center, and Dr. Kverno is Assistant Professor, Johns Hopkins University School of Nursing, Baltimore, Maryland. Authors are encouraged to visit: Wiley Author Services for further information on the preparation and submission of articles and figures. The journals included in the analysis were Archives of Psychiatric Nursing; Issues in Mental Health Nursing; Journal of the American Psychiatric Nurses Association; Journal of Psychosocial and Mental Health Services; and Perspectives in Psychiatric Care. We publish rigorously conducted research, literature reviews, essays and debates, and consumer practitioner narratives; all of which add new knowledge and advance practice globally. Brief report: Reduced anxiety following pivotal response treatment in young children with autism spectrum disorder. The Screen for Child Anxiety Related Disorders (SCAReD) is used for children aged <13 years (Birmaher et al., 1999), whereas the Generalized Anxiety Disorder-7 (GAD-7; Spitzer et al., 2006) is validated for use in children aged ≥13 years. The dosage range for children is 0.25 mg (for children weighing <20 kg [<44 lbs]) or 0.5 (for children weighing ≥20 kg [≥44 lbs]); with a maximum dosage of 3 mg per day (Riddle, 2019). Anyone who wants to read the articles should pay by individual or institution to access the articles. Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED): A replication study. The starting dose of long-acting methylphenidate (Concerta®) is 18 mg each morning and has a duration of effect of up to 12 hours. Pharmacological interventions may be considered when a child with ASD is showing emotional or behavioral dysregulation, including aggression, irritability, and impulsive behaviors that could cause harm to self or others. Non-stimulant medications, such as guanfacine/clonidine (alpha agonists) and atomoxetine (norepinephrine reuptake inhibitor) are FDA–approved for ADHD in children aged ≥6 years and are frequently useful for adjunctive therapy with stimulants (using the lowest effective dose of stimulant). Sensory-related challenges can improve with occupational and physical therapy. (2014), which include monitoring blood pressure, fasting plasma glucose, and lipid profile at 12 weeks and annually (Riddle, 2019). This is a dummy description. 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). (2020) also recommend an ASD–specific therapy called Pivotal Response Treatment (PRT) that focuses on providing and rewarding appropriate social communication and is also helpful in reducing anxiety (Lei et al., 2017). When necessary, medications can be useful in conjunction with nonpharmacological interventions to attain more comprehensive symptom control. Clinical practice for the assessment and treatment of children and adolescents with anxiety disorders. There are three ADHD presentations in the DSM-5: predominantly inattentive, predominantly hyperactive/impulsive, and combined. Attention, Impulsivity, and Hyperactivity. The Journal of Psychosocial Nursing and Mental Health Services is a peer-reviewed, monthly journal for psychosocial and mental health nurses in a variety of community and institutional settings. B. Lisa Beauvois, MSN, FNP-BC, PMHNP-BC; Karan Kverno, PhD, PMHNP-BC, PMHCNS-BC, Children who present to behavioral health care with autism spectrum disorder (ASD) often have overlapping symptoms and co-occurring disorders, such as attention-deficit/hyperactivity disorder (ADHD), anxiety disorders, sleep-wake disorders, and/or emotional/behavioral dysregulation. 6, p. 505. 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. Tell us what you think about Healio.com », Get the latest news and education delivered to your inbox, Journal of Psychosocial Nursing and Mental Health Services, https://doi.org/10.3928/02793695-20201112-02, American Psychiatric Association [APA], 2013, Substance Abuse and Mental Health Services Administration, 2019, Managing Workplace Violence With Evidence-Based Interventions: A Literature Review. Repetitive actions, avoidance, social anxiety, and perseveration associated with ASD can often be helped with concurrent cognitive-behavioral therapy (CBT). Although weight gain is initially less with aripiprazole compared to risperidone, the differences with long-term treatment may not persist (DeVane et al., 2019). Vasa et al. Children and their parents/guardians benefit from cognitive and behavioral anxiety management strategies. & Löwe, B. (2020). Pharmacotherapy of autism spectrum disorder: Results from the randomized BAART clinical trial. Reiersen, A. M., Constantino, J. N. & Todd, R. D. (2008). The challenge for psychiatric–mental health nurse practitioners is to identify the modifiable symptoms and diagnosable disorders and develop a comprehensive treatment plan that reduces risk factors and promotes improved functioning. Journal of Psychiatric and Mental Health Nursing is a Subscription-based (non-OA) Journal. The American Psychiatric Nurses Association (APNA) is your resource for psychiatric-mental health nursing. Parents/guardians are asked to start the medication on a day when the child will be home with them to assess for effectiveness and side effects. Side effects include sedation and hypotension, so these medications are given at bedtime. Consensus development conference on antipsychotic drugs and obesity and diabetes. It’s a 60-credit hour program and takes 18-24 months to complete. Papers are welcomed which draw on single or multiple research and academic disciplines. Copyright © 2000-document.write(new Date().getFullYear()) by John Wiley & Sons, Inc., or related companies. The relationship between community integration and mental health recovery in people with mental health issues living in the community: A quantitative study. The American Association of Nurse Practitioners (2020) supports and encourages implementation of integrated and coordinated health care delivery. Psychiatric nursing or mental health nursing is the specialty of nursing that cares for people of all ages with mental illness or mental distress, such as schizophrenia, bipolar disorder, psychosis, depression or dementia. Psychopharmacology . 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. According to the DSM-5 (APA, 2013), approximately 70% of persons with ASD have one or more co-occurring mental disorders and approximately 40% have two or more. A child- and family-based collaborative approach with clear treatment goals in the context of an inter-professional care team, which includes the primary care provider, therapists, other relevant specialists, and teachers, has been shown to support children with ASD in becoming more successful in managing everyday stressors and regulating emotions and behaviors. & Margari, L. (2020). 37. Anyone who wants to use the articles in any way must obtain permission from the publishers. The current article presents an overview of evidence-based treatment strategies for co-occurring conditions. Sleep Dysregulation. The AAN guidelines provide evidence that melatonin alone or with CBT-Insomnia can reduce bedtime resistance, sleep-onset latency, sleep continuity, and total sleep time in children with ASD (Williams Buckley et al., 2020). All of these risks are worse for risperidone than aripiprazole (Mano-Sousa et al., 2020; Riddle, 2019; Scahill et al., 2016). 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. (2016). About Archives of Psychiatric Nursing. Shephard, E., Bedford, R., Milosavljevic, B., Gliga, T., Jones, E., Pickles, A., Johnson, M. H. & Charman, T.BASIS Team (2019). Before starting a child on a SSRI, it is important to review the potential for adverse effects with the parents/guardians and child. If the sleep problem does not improve with behavioral strategies (e.g., CBT-Insomnia), they recommend the use of low-dose melatonin. This is a dummy description. sees in hospital-based outpatient pediatric psychiatry. Major risks include weight gain, metabolic abnormalities (i.e., elevated glucose, cholesterol, or triglyceride levels), and persistent involuntary movements (e.g., tardive dyskinesia). Collective biography and the legacy of Hildegard Peplau, Annie Altschul and Eileen Skellern; the origins of mental health nursing and its relevance to the current crisis in psychiatry‡. The field is considered in its broadest perspective, including theory, practice and research applications related to all ages, special populations, settings, and interdisciplinary collaborations. 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. Kerns, C. M., Kendall, P. C., Berry, L., Souders, M. C., Franklin, M. E., Schultz, R. T., Miller, J. Antshel, K. M. & Russo, N. (2019). Journal of the American Psychiatric Nurses Association (JAPNA) JAPNA is APNA's academic journal for psychiatric nursing. The PMHNP might consider initiating a low dose of guanfacine extended release at bedtime to augment the continued risperidone treatment. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association [APA], 2013) defines autism spectrum disorder (ASD) as a neurodevelopmental disorder characterized by clinically significant impairment in social, occupational, or other important areas of functioning that present in the early developmental period. SSRIs that have FDA approval for the treatment of major depressive disorder or OCD in children and adolescents and have been shown to have efficacy for the treatment of anxiety disorders include fluoxetine, escitalopram, sertraline, and fluvoxamine (Riddle, 2019). The authors have disclosed no potential conflicts of interest, financial or otherwise. Journals were reviewed for the type of intervention study (qualitative or quantitative); the study do… We publish rigorously conducted research, literature reviews, essays and debates, and consumer practitioner narratives; all of which add new knowledge and advance practice … They have observed increasing difficulties with avoidance behaviors, including school refusal, social isolation, and fears of being separated from his family. If the child's sleep difficulties have not improved within 1 month, further evaluation is warranted. & Herrington, J. 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. The Journal of the American Psychiatric Nurses Association (JAPNA) is a peer-reviewed bi-monthly journal publishing up-to-date information to promote psychiatric nursing, improve mental health care for culturally diverse individuals, families, groups, and communities, as well as shape health care policy for the delivery of mental health services. American Diabetes AssociationAmerican Psychiatric AssociationAmerican Association of Clinical Endocrinologists & North American Association for the Study of Obesity. Although the risk is low, all antidepressants carry a FDA boxed warning for suicidal thinking and behavior up through age 24, so close monitoring is recommended during the first few months of treatment and following dosage increases (Walter et al., 2020). Presents an overview of evidence-based treatment strategies for co-occurring conditions shows difficulty sustaining attention at home and school low-frustration! 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