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Many people with autism report that some self stimulation may serve a regulatory purpose (ie medications used to treat schizophrenia 5 mg oxybutynin for sale, calming medications causing hair loss purchase oxybutynin 5mg free shipping, increasing concentration or shutting out overwhelming sensory input) symptoms narcolepsy cheap 2.5mg oxybutynin with amex. Semantic relating to symptoms xanax overdose proven oxybutynin 2.5 mg the meaning of language New Zealand Autism Spectrum Disorder Guideline 271 Glossary Sensory impairment deficit in sensory function (eg, reduced visual acuity secondary to a primary eye abnormality or to damage of the visual cortex or impaired hearing or any other sensory deficit). Impaired sensory processing functions can affect learning, play, work, socialisation, health and wellbeing. Sensory integration a theory of brain behaviour relationship which explores the organisation of sensory input in order that individuals can effectively interact with the environment by making adaptive responses Sensory modulation ongoing physiological process central to the ability to filter or attend selectively to sensory information Sensori-motor handling a broad range of unrelated treatment techniques focusing on the sensory or motor systems, eg, reflex integration, neuro developmental therapies, patterning etc Sensory overload or a group of symptoms that show over-reactions to sensory defensiveness input. Individuals may show avoidance, seeking, fear, anxiety and even aggression in reaction to sensory stimuli, particularly if they are over-exposed to them. A session typically includes teaching a specific skill, demonstration of the skill through role playing, practice of the skill, and individualised feedback. Social stories narratives written about social situations to assist understanding, to help the person manage their anxiety and sometimes to encourage appropriate behaviour Social validity a skill or behaviour is said to have social validity if it leads to increased adaptive action alternatives for the individual such that he/she is likely to have access to more reinforcements, or is able to have better life circumstance/experiences, ie, that meets a practical or social need for this child and their family Son-Rise intensive training programme based on the idea that the best way to help a child with autism is to follow the child’s lead. When the curriculum or the expectations (activities, schedule and environment) are clear and comprehensible and predictable to both the students and observers. Structured environments which are planned to ensure that students have environments a clear comprehensible programme and environment Supported employment formal programmes providing ongoing support (flexible, individualised, for an indefinite time) to find and maintain real paid work (paid at no less than market pay rates and under standard conditions) in ‘integrated’ settings alongside people without disabilities. Supported employment is to be distinguished from sheltered employment where people work alongside other people with disabilities in a segregated, specially tailored settings and are commonly paid below market-rate wages. Symbolic or dramatic involves the use of pretence or the deliberate play misrepresentation of reality, as in pretending to eat a non existent cookie or using a block as if it were a truck Symptom substitution where an individual learns to eliminate one behaviour, but substitutes another behaviour to get the same gain Systematic instruction planned, explicit, intentional teaching based on thorough assessments Tactile relating to the sense of touch Tactile defensiveness hypersensitivity to senses of touch Tardive characterised by tardiness, lateness. Used of diseases and disorders in which characteristic symptoms appear relatively late in the normal course of the disorder. Tardive dyskinesia a movement disorder consisting of repetitive, involuntary, purposeless movements, resulting from the use of antipsychotic medications. The individual is aware of the movement but is unable to prevent the movement from happening. Time-out (from a behavioural strategy whereby a child is removed from their reinforcement) usual environment. In autism, can also be used to describe giving the child ‘down time’ to assist with anxiety and stress. Tourette syndrome a disorder of the nervous system characterised by repeated involuntary movements and uncontrollable vocal sounds called tics. Examples of major transitions include movement from early childhood education settings/day care to school, between schools, and from school into work, vocational services or further education. Examples of daily transitions include movement from house to car, lino to carpet, entering another space, changes to new living environment, going to bed. Trial teaching using assessment to determine a child’s rate of learning using particular strategies during a trial period Tuberose sclerosis a disorder associated with autistic behaviour. It is inherited as an autosomal dominant trait, but a substantial proportion of cases represent new mutations. Typically developing children whose development is following the expected path peers Twilight time (in relation to teachers) the time after school or in the evening Vestibular the sensory system that responds to the position of head and body movement and coordinates movements of the eyes, head and body. New Zealand Autism Spectrum Disorder Guideline 275 Glossary Video modelling using video to model or convey meaningful information. This is also a specific strategy where videos are constructed of the individual in question performing an action correctly. Visual (cuing, supports, written, pictorial or photographic schedules, lists, sequence symbols) supports that convey meaningful information in a permanent format for later reference. The purpose of such supports is to allow individuals with autism to function more independently without constant verbal directions. Visual therapy therapy which aims to improve visual processing or visual spatial perception Visual-spatial skills cognitive abilities that relate to the way people perceive the objects and surroundings of their environment Vocational services employment services, or services which find or provide meaningful daytime activities Well Child/Tamariki the Well Child/Tamariki Ora Framework covers screening, Ora education and support services offered to all New Zealand children, from birth to five years, and to their families/whanau. Well Child services encompass health education and promotion, health protection and clinical support, and family/whanau support. They also ensure that parents are linked to other early childhood services, such as early childhood education and social support services, if required. Providers of Well Child services include registered nurses and community health workers/kaiawhina who have specific training in child health (see also Tamariki Ora in Glossary of Maori and Pacific Terms). Young Autism Project see Lovaas method 276 New Zealand Autism Spectrum Disorder Guideline Glossary Glossary of Maori and Pacific terms Aroha love in its broadest sense Fono to gather together; have a meeting Haka fierce rhythmical dance Hui a gathering following Maori protocols Iwi tribe, bone, people Kai food Kaiarahi guide Kaiawhina support person Kanohi ki the kanohi face-to-face communication Karakia prayer, ritual chant Karanga ritual call of arrival and welcome Kaumatua respected elder (men and women) Kaupapa purpose Kawa protocol, procedure Kohanga reo Maori-medium early childhood education centre Kuia respected female elder Kura kaupapa Maori Maori medium school based on Maori practices and philosophies Manaaki care for, provide support in a respectful manner Mana atua wellbeing Mana aoturoa exploration Mana reo observing the local language of the region Mana tangata people upholding the prestige of the local area Mana whenua tribal people of the local area Marae cultural meeting ground or place Mihi greet, introduction Poi swinging ball used in a traditional dance Pono truth, a validity principle Powhiri formal welcoming ceremony Raranga weaving Runanga regional Maori council New Zealand Autism Spectrum Disorder Guideline 277 Glossary Taiaha long-handled, two-handed weapon used in traditional Maori martial art form Tamariki Ora Well Child – a national schedule of services that provide ‘well child’ care, including screening, surveillance, education and support services to all New Zealand children from birth to five years and their family or whanau Tapu sacred The reo Maori the Maori language The Whariki the New Zealand early childhood curriculum The Whare Tapa Wha framework of Maori health (four-sided house) Tika authentic, observing custom Tikanga customs, protocol, rules, principles Tohunga expert Waiata song Waka-ama outrigger canoe paddling Wananga discussion, place of learning Whakama shy, embarrassed Whanau extended family Whanaungatanga kinship, relationship 278 New Zealand Autism Spectrum Disorder Guideline Glossary Appendices “I am tired of having to do 100% of the changing, and there is no change with most people without autism. Ministry of Health led the Support and Transition workstream, which commenced Workstream input in April 2004. The Paediatric Society led the Assessment and Diagnosis workstream, supported and independent living formerly known as the Early Intervention options workstream, which was established in physical wellbeing November 2002. This group consisted of up workstream, which commenced work in to two representatives from each of the March 2003. This workstream covered: three workstreams and the project support for families’ involvement in manager. The workstreams leaders and Ministries of Education and also established advisory development Health identified the need for a more groups to assist in the development and focused and specific Maori input. Following methodology for the development of the advice from the Maori Advisory Group, guideline. The feedback from Paediatrics and Child Health and the All the hui was analysed and incorporated with 11 Party Parliamentary Group on Autism the other Maori research and information into document is available from: the section of the guideline on Maori This is the full version on which this part of guideline is based and to Pacific peoples’ input which the reader should refer for the evidence base and rationale for In 2004, a fono was held to discuss how recommendations. A range of Best Practice Guidelines for Screening, different perspectives was gathered and a Diagnosis and Assessment developed by report was produced to summarise the the California Department of findings of the fono. This information was Developmental Services 2002,33 then developed into a section of the New Zealand Autism Spectrum Disorder Guideline 281 Appendices the New Zealand Guideline Development often single case reports. It was the study subjects outside the 0 to 12 years assessed as being an appropriate document criteria and thus recommendations may to be adapted for the New Zealand have a relevance to older children. It is intended that this work be interventions suitable for children with undertaken at a later date. The search was aimed at finding literature Workstream 2 relevant to children aged 0 to 12 years. A list of abstracts was generated from Major sections of Parts 2 and all of Part 3 of about 900 papers. A list of relevant papers the guideline were developed by a small was generated from these abstracts and working group consisting of five people evidence tables were compiled. Additional autism-specific studies – study subjects expertise was incorporated through included individuals diagnosed with feedback from a consultancy group. The group conducted its own systematic reviews searches of the literature up until April case reports of adverse effects (with 2004, assisted by the library at the Ministry particular reference to drugs in current of Education. Because of time and resource use in New Zealand) constraints, evidence was drawn primarily from existing published guidelines and papers of general interest on the topic. In addition, two dietary Family Index databases were searched approaches have been described. Eight using the descriptors ‘autism spectrum classes of medications were reviewed by disorders’. Searches were also undertaken were described in only one or two papers, 282 New Zealand Autism Spectrum Disorder Guideline Appendices to seek material on effective practice, assessment and diagnosis of young people adolescents, families, behaviour, and adults. Additional contributions were transitions and inclusion in relation to merged into Parts 2 and 4. The criteria for selection of studies were as follows: the scope of topics to be included was initially wide ranging but refined after For guidelines: consultation, because of resourcing and time issues. The communication support published evidence was critically appraised care and protection and evidence tables developed with levels of evidence for each study. The content of alternative treatments the guideline was decided upon by interface between relevant New Zealand consensus, based on the sources of agencies evidence. Practice questions and topics were defined and a systematic, hierarchical search of Workstream 3 medical, psychological and social science databases was performed in July 2004. This workstream, set up by the Ministry of Further searches were also performed by Health and the Disability Services accessing relevant organisations and Directorate, was made up of two internet websites for policy and position workstream leaders and a virtual team of papers, textbooks, reports and guidelines. The writers contributed using the New Zealand Guideline Group separate sections, reflecting the different process.

The discomfort primarily occurs as a result of either factors that induce secondary physiological and behavioural cardiovascular or respiratory system compromise medications prolonged qt discount oxybutynin uk, but may also be responses symptoms 5dpo purchase oxybutynin without a prescription. In the evaluation and management by pulmonary ventilation not matching the drive to medicine 4h2 pill buy oxybutynin 5mg breathe medications in checked baggage buy on line oxybutynin. Muscle spindles in the chest wall signal the Definition stretch and tension of the respiratory muscles. The central breathing, chest tightness, and air hunger (a feeling of not enough processing in the brain compares the afferent and efferent signals air on inspiration). It derives from interactions among motor commands to the ventilatory muscles are effective, meeting 32 January 2016, Vol. Bronchiolitis obliterans S: Social issues Intrabronchial neoplasm P: Physical problems, pain Tracheomalacia N: Non­acceptance or spiritual/existential distress Obstructive sleep apnoea E: Economic or financial distress Restrictive A: Anxiety or anger. It is imperative to detect warning signs that require Pneumocystis pneumonia immediate attention, as the patient may have a life­threatening Eosinophilic pneumonitis cause of dyspnoea. Vascular With regard to the clinical evaluation, there are two major Pulmonary embolus (acute/chronic) categories of patients: those with new onset of breathing Idiopathic pulmonary hypertension discomfort for whom the underlying cause of dyspnoea has not yet been determined; and those with known cardiovascular, Continued 33 January 2016, Vol. Moreover, the Guillain­Barre syndrome history should determine the character, onset, duration, associations, Myasthenia gravis severity, relation to exertion and any exacerbating/relieving factors. Pleuritic chest Uncommon Pulmonary contusion pain results from pericarditis, pneumonia, pulmonary embolism, causes Angio­oedema pneumothorax, or pleuritis. Chest pain almost always occurs in Trauma spontaneous pneumothorax, while dyspnoea is the second most Foreign body aspiration common symptom. Anginal chest pain accompanied by shortness Retrosternal goitre of breath may signify ischaemia associated with left ventricular Vocal cord dysfunction dysfunction. Sudden shortness of breath at rest suggests pulmonary Pulmonary hypertension embolism or pneumothorax. A history Pulmonary arteriovenous malformations of scuba diving may suggest barotrauma. The clinician should Pleuritis note a history of penetrating or non­penetrating trauma. Dyspnoea may also present as orthopnoea (breathlessness on assuming the respiratory, or neuromuscular disease who are experiencing supine position) and paroxysmal nocturnal dyspnoea (attacks of worsening symptoms. The attending bly lead to identification and successful management of the physician should enquire about indigestion or dysphagia, which may underlying cause. The typical scenario is may imply psychogenic causes of dyspnoea, but organic causes a young person without a notable medical history, with normal should always be excluded first: a diagnosis of hyperventilation oxygen saturation in room air, who complains of breathlessness syndrome cannot be made before organic disease is ruled out. Psychogenic Medication use is another important consideration, especially dyspnoea responds well to reassurance (and acknowledgement drugs with potential adverse cardiopulmonary effects. This is a component of the evaluation of patients haemoglobinaemia (dapsone and sulfonamides); and acute or chronic with suspected pulmonary embolism. Aspirin sensitivity is a cause the sensitivity of D­dimer is much greater than its specificity, and of asthma in a significant number of patients. In patients with a low pretest probability, a an indication of consolidation or effusion. Wheezing is usually consistent also be safely excluded on the basis of a Wells score of 4, combined with obstructive lung disease, but can be caused by pulmonary with a negative qualitative point­of­care D­dimer test result. Short­term admin­ in the diagnostic process, because it allows a panoramic view, at the istration reduces breathlessness in patients with a variety of condi­ same time being cost­effective, safe and time saving. Recent evidence­based clinical guidelines recommend pathic dilated cardiomyopathy (21. These can be particularly helpful management of patients with chronic lung disease. Identifying non­respiratory causes of exercise limitation self­reported dyspnoea with activity. Evidence that other components of this differential experience of dyspnoea among individuals emanates pulmonary rehabilitation. The management of dyspnoea will depend on likely that individual characteristics, such as motivation, are relevant. An ofcial American Toracic Society Statement: often report that movement of cool air reduces breathlessness, Update on the mechanisms, assessment, and management of dyspnea. Two hands (from roughly the patient’s size) are applied as follows: upper little fnger just below clavicle, fngertips at middle line, and lower hand just below upper hand (thumbs excluded). Tese four points roughly follow the anatomy of the lung, and avoid the heart as much as possible. Exactly from and below the pleural line (arrowheads), the pattern is sandy, hence, the seashore sign. The most frequent cause of respiratory failure was Alveolar syndrome (lung consolidation) is also an old 53 pneumonia (32%) followed by acute hemodynamic diagnostic application of lung ultrasound. Lung Pleural eusion47 94 97 sliding (or its equivalent, the lung pulse)58 or B-lines Alveolar consolidation48 90 98 rule out pneumothorax. In free pleural efusions, the lung line moves distance between the pleural and lung lines in this standardized view toward the pleural line on inspiration, shaping the sinusoid sign, a basic taken on expiration is 25 mm. The A-profle is shorthand for “anterior lung ultrasound flow penetrates the lung, but the major sliding with A-lines profile. The principle of lung ultrasound, consolidations seen in machine is brought to the bedside, the probe applied at Figure 7 – A, B, Lung rockets. An elementary signature of interstitial syndrome, the B-line, can be described by seven criteria. The frst step is to detect the A9-profle is detected (at the anterior wall, by defnition), the search for A9-profle, associating the A-line sign with the abolition of lung sliding. The arrows indicate the pleural equipment is suitable (real-time instant-response acquisition, suitable line. Arrows in the lef image indicate the Note that the two images are not only side by side but also exactly side by pleural line. Echocardiography is associated but A-lines defines the A-profile, and a venous scan is not included (searching for lef-sided heart anomalies done following a sequential order. In its absence, a cardiogenic shock from lef origin (ie, the far majority) can be ruled out by defnition. The A-profile shows that fluids can be administrated, a notion of interest for intensivists who use volume resus citation in distributive shock. Previous guidelines recommended early and massive The apparition of anterior B-lines (one can search more fluid therapy in sepsis. The use of lung ultrasound by these common bond: providing therapeutic orientations. One may, for instance, interest to not only those who have not yet mastered initiate a curriculum with the normal lung and become expert echocardiography but also those who do not yet rapidly operational for basic applications (pneumothorax, (or will never) have echocardiographic units. With a roughly 60% to 70% sen where each second is precious for sequentially pinpointing sitivity, it appears to be a suboptimal tool in critical reversible causes, including pneumothorax, pulmonary care. In the critically ill neonate, the 10 to 12 signs tive data for all disorders (as shown in the fgure legends assessed in adults are found, with no diference. Transthoracic sonography of difuse paren using ultrasound, physicians take part, aware or not, in chymal lung disease: the role of comet tail artifacts. Ultrasound estimation of volume Acknowledgments of pleural fuid in mechanically ventilated patients. Chest ultrasonography for the diagnosis and moni toring of high-altitude pulmonary edema. Diagnostic procedures in respiratory sound lung comets by chest sonography in patients with dyspnea diseases. Soldati G, Testa A, Sher S, Pignataro G, La Sala M, Silveri statement on competence in critical care ultrasonography. Occult traumatic pneumothorax: diagnostic accuracy of 2009; 135 (4): 1050 1060. Refected ultrasound in the in systemic sclerosis: a chest sonography hallmark of pulmonary detection and localization of pleural efusion. Prospective application of clinician point”: an ultrasound sign specifc to pneumothorax. Prospective evaluation of point of-care ultrasonography for the diagnosis of pneumonia in children 62. Technique and clin for predicting pulmonary artery occlusion pressure in the critically ical applications. Feasibility and safety of ultrasound-aided thoracentesis in mechani 2012;27(5):533.

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Bowel gut axis probably impairs colonic transit and ano disorders in gulf war veterans 9 medications that can cause heartburn purchase oxybutynin with american express. Influence of dietary medicine jar paul mccartney purchase oxybutynin on line amex, psychological medications side effects prescription drugs 5 mg oxybutynin amex, and its impact during the treatment of affected children treatment internal hemorrhoids purchase 5mg oxybutynin with mastercard. Physiologic and psychologic characteristics of an elderly population References with chronic constipation. Relationship between psychological state and level of Epidemiology of childhood constipation: a systematic activity of extrinsic gut innervation in patients with a review. Government does not warrant or assume any legal liability or responsibility for the accuracy, completeness, or usefulness of any information, apparatus, product, or process disclosed. This latest revision takes a new approach to defining the criteria for mental disorders—a lifespan perspective. The perspective recognizes the importance of age and development in the onset, manifestation, and treatment of mental disorders. The May 20, 1993, Federal Register describes responses to public comments received in response to the 1992 notice. A smaller set of comments focused on the inclusion or exclusion of certain disorders such as substance abuse, developmental disorders, and attention deficit disorder. Developmental disorders (mental retardation, autism, pervasive developmental disorders) were also excluded. These three studies assess slightly different age groups, use different diagnostic instruments, and include the assessment of slightly different childhood mental disorders (see Table 1). Meanwhile, Merikangas and colleagues (2010) operationalized four levels of impairment for each disorder assessed: level A, intermediate or severe rating on one question; level B, intermediate or severe rating on two questions (level A and B are not mutually exclusive); level C, severe rating on one question; and level D (severe impairment), included meeting criteria for either level B or C. This latest revision takes a lifespan perspective recognizing the importance of age and development on the onset, manifestation, and treatment of mental disorders. Other changes in the Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Many of these general changes from Diagnostic and Statistical Manual of Mental Disorders, 4th ed. However, the direct impact on the prevalence rates of childhood mental disorders is likely to be negligible as it will not affect the characteristics of diagnoses. As a result of these changes in the overall classification system, numerous individual disorders were reclassified from one class to another. Disorders usually first diagnosed in infancy, Dropped1 childhood, or adolescence 2. Although diagnosis is rare for children younger than 4 years old, symptoms must be present in early childhood even if not recognized until later. Persistent difficulties in the social use of verbal and development of reciprocal social interaction or nonverbal communication as manifested by all of the verbal and nonverbal communication skills, or following: when stereotyped behavior, interests, and 1. Deficits in using communication for social purposes activities are present but are not met for a 2. Impairment of the ability to change communication to specific pervasive developmental disorder. Difficulties for following rules for conversation this category includes "atypical autism" (late (taking turns, use of verbal/nonverbal signs to regulate age of onset, atypical symptomatology). The deficits result in functional limitations in effective communication, social participation, social relationships, and academic achievement. The onset of the symptoms is in the early development period, but may not fully manifest until social communication demands exceed limited capabilities. The symptoms are not attributable to another medical or neurological condition or to low abilities in the domains of word structure and grammar, and are not better explained by autism spectrum disorder, intellectual disability, or developmental delay. A diagnosis requires symptoms to be present in at least two settings (at home, at school, or with peers) for 12 or more months, and symptoms must be severe in at least one of these settings. In addition, chronic childhood irritability has not been shown to predict later onset of bipolar disorder, 11 suggesting that irritability may be best contained within a separate mood dysregulation category (Leigh, Smith, Milavic, & Stringaris, 2012). Severe recurrent temper persistently elevated, expansive, or and defiant behavior lasting at outbursts manifested irritable mood, lasting at least 1 week least 6 months, during which verbally. The temper outbursts are disturbance, three (or more) of the inconsistent with following symptoms have persisted developmental level (four if the mood is only irritable) and have been present to a significant degree: 1. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation 7. Excessive involvement in pleasurable activities that have a high potential for painful consequences. The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and it is observable by others E. Throughout that time, the individual has not had a period lasting 3 or more consecutive months without all of the symptoms in criteria A-D. Criteria A-D are present in severe to cause marked impairment in causes clinically significant at least two of three occupational functioning or in usual impairment in social, academic, settings social activities or relationships with or occupational functioning (home/school/peers) and others, or to necessitate are severe in at least one hospitalization to prevent harm to self setting or others, or there are psychotic features. The diagnosis should not disorder, and if the individual is be made for the first time age 18 years or older, criteria are before age 6 or after 18 not met for Antisocial Personality Disorder. There has never been a distinct period lasting more than 1 day during which the full symptom criteria, except duration, for a manic or hypomanic episode have been met. Note: Developmentally appropriate mood elevation, such as occurs in the context of a highly positive event or its anticipation, should not be considered as a symptom of mania or hypomania. Disorder Class: Mood Disorders Disorder Class: Attention-Deficit Disorder Class: Depressive Manic Episode and Disruptive Behavior Disorders Disorders Oppositional Defiant Disorder Disruptive Mood Dysregulation Disorder J. The behaviors do not occur exclusively during an episode of major depressive disorder and are not better explained by another mental disorder. The symptoms are not direct physiological effects of a attributable to the substance. A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) and/or (2): 1. Inattention: Six (or more) of the following inattention have persisted for at least 6 months to a symptoms have persisted for at least 6 months to a degree that is maladaptive and inconsistent with degree that is inconsistent with developmental level developmental level: and that negatively impacts directly on social and academic/occupational activities: Note: the symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or failure to understand tasks or instructions. Often fails to give close attention to details or careless mistakes in schoolwork, work, or other makes careless mistakes in schoolwork, at work, or activities during other activities. Often has difficulty sustaining attention in tasks or play activity play activities. Often does not follow through on instructions and fails to finish schoolwork, chores or duties in the fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or workplace. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as tasks that require sustained mental effort. Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts). Hyperactivity and impulsivity: Six (or more) of the hyperactivity-impulsivity have persisted for at least following symptoms have persisted for at least 6 6 months to a degree that is maladaptive and months to a degree that is inconsistent with inconsistent with developmental level: developmental level and that negatively impacts directly on social and academic/occupational activities: Note: the symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or a failure to understand tasks or instructions. For older adolescents and adults (age 17 or older), at least five symptoms are required. Often leaves seat in situations when remaining in which remaining seated is expected seated is expected. Often runs about or climbs in situations where it is in which it is inappropriate (in adolescents or adults, inappropriate. Often unable to play or take part in leisure activities activities quietly quietly. Several inattentive or hyperactive-impulsive symptoms must have been present before age 7 symptoms were present before age 12 years. There is clear evidence that the symptoms interfere significant impairment in social, academic or with, or reduce the quality of, social, school, or occupational functioning. The symptoms do not occur exclusively during the course of a pervasive developmental disorder, course of schizophrenia or another psychotic schizophrenia, or other psychotic disorders and is disorder and are not better explained by another not better accounted for by another mental disorder mental disorder. Moderate: Symptoms or functional impairment between "mild" and "severe" are present. The arousal cluster will now include irritability or angry outbursts and reckless behaviors. Clinical re-experiencing can vary according to developmental stage, with young children having frightening dreams not specific to the trauma. Young children are more likely to express symptoms through play, and they may lack fearful reactions at the time of exposure or during re experiencing phenomena. It is also noted that parents may report a wide range of emotional or behavioral changes, including a focus on imagined interventions in their play. The preschool subtype excludes symptoms such as negative self-beliefs and blame, which are dependent on the ability to verbalize cognitive constructs and complex emotional states.

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Sarah then changed her reports when she was interviewed by the police and the assaults were not legally substantiated and no child protective action was taken symptoms zithromax buy oxybutynin 2.5mg visa. After one of these events medications on nclex rn generic 5mg oxybutynin with mastercard, Sarah began showing more externalizing behaviors in her father’s home and he returned both girls to medications qt prolongation oxybutynin 5 mg without a prescription Jenny because she had stopped using drugs and had become more stable medications derived from plants order oxybutynin 5 mg without a prescription. At the time of the referral, Sarah had only recently returned to her mother’s home. Sarah and her older sister began to tell Jenny about the assaults a few months they after they arrived in her home. Though Jenny did believe her daughter, she did not know how to respond to her, especially given Sarah’s multiple problems. Sarah, however, did not, and may not have been able to, address her emotions related to her past in these more verbal conversations. In the frst session, they were coached to develop short, interactive scenes using the techniques of creating, drawing, and then enacting various storyboards. They were encouraged to address themes of mastery and to correct some of Sarah’s cognitive errors, such as self-blame. In one session, Sarah drew a cartoon in which she showed herself thinking she was at fault and a bad girl in a thought bubble above a picture of herself with her father spanking her. In a discussion a few minutes after this, Sarah revealed that this drawing was of the event in which her father had used physical punishment after she had reported that his male housemate had sexually assaulted her in the bathroom. Unfortunately, the father had not believed her and was punishing her in an effort to have her change her reports to the police. In this session, the therapist and the mother were able to help add additional thought bubbles that Sarah was not a “bad girl” and that she had many feelings she would become able to express. Once Sarah and Jenny could maintain a dramatic improvisation together, Sarah was asked to develop a story with her mother. This story was introduced after a night when Sarah reported particular diffculty with nightmares and suicidal thoughts. While Jenny required some coaching to follow her daughter’s dramatic ideas, Sarah was easily able to develop a scene with characters for her mother, the therapist, and herself using the puppets. In this enactment, Sarah cast herself as a snake who had been hurt in an accident. Using Sarah’s stage directions and lines, this new person (a doll) tried to talk the snake out of future attacks; however, the snake remained unconvinced. The bite was harmless, however, and fnally the snake became convinced of the doctor’s good intentions. The snake and the doctor became friends and travelled to another country to help other snakes learn not to bite people unnecessarily. The scenes ended with Sarah asking everyone to play music and learn to dance like the snake following her lead. Both Sarah and Jenny were able to be quite engaged in the dramatic and emotional fow of the session. The metaphors helped them communicate the complex feelings related to their history that they had not been able to address prior to the session. As the improvi sation developed, Jenny could become a signifcant supportive fgure for her daughter, as if she were an emotional “doctor” who could withstand “snake bites. The dramatic enactment became a special stage where the characters and exchange provided heightened intimacy that they were not able to achieve in more normal verbal conversations. This positive emotional exchange occurred within the enactment and did not require interpretation or further discussion to help Jenny and Sarah change their relationship. Jenny and Sarah were encouraged to continue to develop storytelling with each other in the week following at home. In the days following this enactment, Sarah was able to disclose much of what had occurred during the previous abusive events, and her mother was able to respond sup portively. While Sarah and her mother were seen for other sessions, this enactment was the turning point when their situation became more positive. Sarah’s suicidal thoughts stopped shortly after this, as did her stealing and fre play. This enactment facilitated several changes the family was able to make over the next several weeks. Some of the main contributors to the professional literature in each feld, such as Cat tanach, Gallo-Lopez, and Harvey, have credentials in, have helped develop, and have presented at professional conferences in the areas of both play and drama therapy. In addition to graduate training, certain personal characteristics make some therapists better suited to the use of drama within play therapy sessions. These characteristics include an appreciation of and ability to use overt dramatic expression. Some experience with dramatic performance is helpful, as clients will often ask therapists to play a part in their enactments, and these performances require a commit ment to the role. The therapist will also need to set up and direct scenes and improvisations for families. Interper sonal fexibility, spontaneity, a good sense of humor, and the ability to read social situations are perhaps the most important characteristics for the therapist using dramatic interventions because the dramatic enactments of children and their families can require multiple types of intervention, even within a single session. Harvey (2008a) and Jennings (2010) present ways of adapting this work with for use with very young children, and Schaefer and Gallo-Lopez (2005b) and Emunah (1985) present applications for use with adolescents. This chapter, however, mainly addresses using drama with children of primary and intermediate school age. Because dramatic play occurs as part of normal development, there are few contraindications for using these approaches with most children. However, some caution needs to be taken with children who have diffculty with reality testing. If children are not able to make this distinction, dramatic play should not be attempted until the child is better anchored in reality. Although the material in this chapter has focused on the inclusion of dramatic techniques in play therapy for individual children and their families, it has also been used in traditional therapy groups as well as therapeutic performing groups. As such, there is far less emphasis on toys and more on materials that facilitate participants’ development of characters and dramatic scenes or settings. Different therapists have suggested a variety of playroom set ups to accomplish this. Irwin (2014) suggests the room for younger children should contain some props that are more typical of a play therapy room: a sandbox, plastic buckets, spoons, art materials, dolls, and miniature life toys, such as trucks, planes, police cars, farm animals, soldiers, doctor kits, tanks, and miniature family kits. For older children, she suggests including a large variety of puppets along with a puppet stage, craft materials, and costume pieces. Harvey (2003, 2005, 2011a) has suggested using far fewer toys so as to direct the projection to a specifc interactive activity. The setup should include a room with a large open space so children and adult family members can move their bodies in an expressive way, large pillows that can be used with activities such as making houses or to symbolize various “lands,” and life-sized stuffed animals that can be readily and easily included as characters in scene development. A large variety of colorful scarves and parachutes is useful because these items can (a) become props in setting up a scene (such as indicating lakes, rivers, or volcanic lava), (b) become costume pieces, or (c) be used in physical interactions such as tug of wars within the dramatic action. Art materials, including large paper, whiteboards, and a variety of music-making instruments can be used out draw out action plans, create music to accompany the dramas, or create scenery and props as they are required. Harvey also suggests the use of video cameras to record and review short scenes developed within the enactment portions of the session. The use of such nonspecifc materials (especially soft pillows and scarves) ensures the material can be changed to the keep up with the moment-to-moment improvisation of dramatic action. The large pillows, for example, can be used for a caregiver and child to run into one another and fall at one moment, only to be set up and used as a wall or made into a house for the large stuffed animals the next moment. The whiteboard is useful for keeping score of ongoing improvisational scenes with a competitive interaction or as a way to draw out the scenes that have happened or are about to happen as a way of extending the drama in another expressive media. Video reviews of short scenes can be particularly useful in planning and organizing new scenes with alternative endings to enrich theme and character development. Information should be collected on the presenting Pthomegroup Using Drama in Play Therapy 305 problems, the child’s developmental history, family history, as well as any history of medical or mental illness, school performance, and peer socialization. Information concerning family sepa rations, deaths of signifcant family members, family violence, or other history of psychological trauma experienced by the child or other family members should also be obtained. Standard mea sures, including problem inventories, specifc instruments to measure depression and anxiety, and standardized measures of adaptive development, help to augment the intake. Summaries of these assessments can be used to determine whether referrals to other disciplines, such as psychiatry, special education, or other family services, should be considered. As with any form of treatment, ongoing dramatic play therapy should not be conducted in isolation when the presenting problems are multifaceted.

This reaction to medications januvia purchase oxybutynin 5mg fast delivery light-headedness medications 5 songs cheap oxybutynin 5mg, dizziness medicine 802 generic oxybutynin 2.5mg with mastercard, tingling is unrelated to medications 2355 buy oxybutynin 5mg amex the content of the vaccine. Younger children tend to react differently Fainting is relatively a common injection reaction among individuals who are to anxiety. Fainting can be anticipated vomiting, or breath-holding which can when immunizing older children, and cause unconsciousness. In some cases can be reduced by minimizing stress children may develop convulsions as a in those awaiting injection, through result of anxiety; however they do not short waiting times, comfortable room need to be investigated but should be temperatures, preparation of vaccine out reassured. Fainting does not require any In a group situation, mass hysteria is management beyond placing the patient possible, especially if a vaccinee is seen in a recumbent position. Clear from the fall is important, and those at explanations about the immunization and risk should be immunized while seated. The local lesion a live attenuated (weakened) strain of begins as a papule, two or more weeks Mycobacterium bovis. It does not prevent typically as a result of improper injection primary infection and does not prevent technique when the vaccine is given into reactivation of latent pulmonary infection. An adherent or fstulated lymph gland may be drained and an anti Hepatitis B vaccines products are tuberculosis drug may be instilled locally. It should not be frozen or exposed traditionally has been seen in children to freezing temperatures. The l A 4-dose schedule may be infection is spread by direct contact with administered if a birth dose is given and a combination vaccine is used to blood and body fuids. Diphtheria is caused by toxigenic strains l Children over 7 years of age and of corynebacterium diphtheriae. Usually adults, who have not been immunized the infection presents as membranous during infancy, three doses of vaccine nasopharyngitis or obstructive are required with an interval of 4-6 laryngotracheitis. Other serious weeks between the frst and second complications of diphtheria include doses, and 6-12 months between the myocarditis and peripheral neuropathies. It is hypotonic hyporesponsive episode) characterized by generalized rigidity and within 48 hours after receiving a convulsive spasms of skeletal muscles. The muscle stiffness usually involves the jaw (lockjaw) and neck and then l Seizure 3 days or more after receiving becomes generalized. All tetanus containing vaccines should be l Progressive or unstable neurologic stored at 2-8°C. They should not be frozen disorder, uncontrolled seizures, or or exposed to freezing temperatures. The minimum interval between vaccine: defer vaccination until at least 1st and 2nd doses and between 3rd 10 years have elapsed since the last and 4th doses is 4 weeks. The primary series is 3 to 4 doses depending on the l History of Arthus-type hypersensitivity individual’s vaccination history; refer reactions after a previous dose of to catch up immunization schedule tetanus or diphtheria toxoid-containing section {2. Polio is an infectious disease caused l Exaggerated local (Arthus-like) reaction by a virus that lives in the throat and is occasionally reported following intestinal tract. Most of polio infections receipt of diphtheria or tetanus are unapparent or asymptomatic and containing vaccine. The reaction less than 1% of all polio infections result presents as extensive painful swelling in faccid paralysis. The disease affects from shoulder to elbow starting 2-8 the anterior horn cells of the spinal cord hours after injection. Measles recommended 5 years after the frst causes fever, runny nose, cough and -54 Immunization Guidelines Department of Public Health & Safety, Health Policy & Strategy Sector rash. Measles vaccine is available as l Moderate reactions including monovalent (measles only) formulation, febrile seizure, arthralgia, and and in combination formulations such thrombocytopenia. Central produces a subclinical or a mild disease nervous system involvement and orchitis characterized by rash, mild fever and are relatively common complications. Occasionally patients Some other rare complications include develop arthralgia, thrombocytopenia, thyroiditis, myocarditis, pancreatitis, and and rarely encephalitis. Chickenpox is an infectious disease caused by the varicella-zoster virus, l Persons aged >13 years without which results in a blister-like rash, evidence of varicella immunity should itching, tiredness, and fever. Adults, receive two doses of single-antigen infants, adolescents, and immuno varicella vaccine administered compromised people are more likely subcutaneously, 4-8 weeks apart. It is possible for these people to infect other members of their Varicella vaccine can be administered as household, but this is extremely rare. However, other anaphylaxis) after a previous dose or brands of single varicella or combination to a vaccine component. Pediatric formulations are l the safety of hepatitis A vaccination given to children 1-18 years of age and during pregnancy has not been adult formulations are recommended to determined. It should not be frozen or exposed negative, diplococcus responsible for to freezing temperatures. Meningococcal meningitis reconstituted vaccine contains 50 mgm presents as fever, stiff neck and a of each polysaccharide group. Up to 19% of all survivors suffer serious sequelae like Meningococcal polysaccharides deafness, neurologic defcits or limb loss. Vaccine: Invasive meningococcal disease is l Mencevax is a Lyophilized preparation acquired by aerosol or direct inhalation of purifed polysaccharides from of respiratory secretions from a healthy Neisseria meningitidis (meningococcus) or sick person. Meningitidis has several adults against meningococcal disease sero-groups based on differences in the caused by meningococci of serogroups capsular proteins. However, recent reports of W-135 children over 5 years of age immunity meningococcal disease in Saudi Arabia will persist for up to 3 years. Conjugate polysaccharides from meningococci of vaccines induce enhanced levels of anti the respective sero-groups. It is licensed either bivalent (A and C) or quadrivalent for active immunization for ages 2 years (A, C, Y and W-135). Meningococcal Polysaccharide diphtheria the recommended single dose of toxoid conjugate vaccine (Menactra) is -59 Specifc Vaccines conjugate vaccine and is approved for 9 swelling at the injection site that months through 55 years of age. More for children 9 months – 23 months of common with the conjugated vaccine age is 0. Human Infuenza can be caused by one l Children who receive primary of three Infuenza viruses A, B or C. Please refer to given to targeted high risk groups section for live virus vaccines. In addition, for the close, of severe gastroenteritis in infants and household contacts of people who are in young children worldwide. The clinical the high risk group, vaccination is a good spectrum of rotavirus illness in children strategyInfuenza vaccine must be given ranges from mild, watery diarrhea of annually. Both products administered to infants with acute differ in composition and schedule of moderate or severe gastroenteritis until administration. Serious complications include -62 Immunization Guidelines Department of Public Health & Safety, Health Policy & Strategy Sector intestinal hemorrhage or perforation. A third heat-phenol parenteral inactivated vaccine is also available, but Typhoid vaccination is recommended for: its use is associated with substantially l Travelers to areas where a risk of more adverse reactions, with no increase exposure to S typhi is recognized. Afghanistan, Latin America, and Africa, who have prolonged exposure to Oral Ty21 a vaccine is indicated for contaminated food and drink. The vaccine should be taken as typhoid fever carrier, such as occurs one enteric-coated capsule every other with continued household contact. Each l Laboratory workers with frequent capsule should be taken with cool liquid, contact with S typhi. The capsule must be l Regular booster doses are kept refrigerated and all four doses must recommended for those at ongoing be taken to achieve maximal effcacy. For those 10 years of age and l Oral typhoid vaccine should not older, the dose is 0. If time is insuffcient for administration of two doses of the vaccine at an interval of l History of allergy to typhoid vaccine. Both vaccines are also effective or other live viral vaccines along with for preventing pre-cancer cervical typhoid vaccine is not contraindicated. To total of three injections are given using avoid serious injury related to a either vaccine.

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