ATTENTION DEFICIT HYPERACTIVE DISORDER

CONTENTS Introduction Causes Diagnose (S&S) Epidemiology Treatment Disease across life span Nursing Care

INTRO: ADHD Termed: Attention deficit, hyperactivity

disorder ADD is no different from ADHD but it refers to

adults in the Diagnostic & Statistical Manual for Mental Disorders (DSM-IV-TR)

ADHD is a diagnosis applied to children and adults who consistently display certain behaviors such as distractibility, impulsivity, and hyperactivity over a period of time.

MYTH AND FACT Myth: ADHD is caused

by bad parenting. Myth: Children who

have ADHD will eventually grow out of it.

Myth: ADHD is not a medical condition.

Fact: ADHD is a neurobehavioural disorder

Fact: 80% of children who have ADHD will continue to have enough symptoms to qualify for diagnosis as an adolescent and over 60% of adults will maintain core symptoms of ADHD.

Fact: ADHD is a biological brain based condition officially recognized by leading medical experts and institutions

CAUSES Specific cause is unknown Twin studies showed that 75% of ADHD

cases are genetically inherited Twin studies also suggested that 9-20% is

also due to environmental factors Pregnancy: smoking, alcohol, and premature

birth Diet: European Food and Safety Authority

(EFSA) conclude in their study that food additive such as artificial food coloring and preservative significantly affects children with ADHD

http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/what-causes-adhd.shtml

PATHOPHYSIOLOGY Dopamine: research study suggests that

various genes affect the neurotransmitter dopamine: Dopamine activation is a reward for the brain ADHD individuals dopamine receptors are not as

efficient as a normal person’s therefore they have a lower dopamine level

PATHOPHYSIOLOGY Delayed in frontal and temporal lobe Accelerated maturity of the motor cortex

DIAGNOSE DSM-IV Criteria for ADHD

I. Either A or B:A. 6 or more of the following symptoms of inattention have been present for at least 6 months to a point that is disruptive and inappropriate for developmental level:

Inattention: poor attention to detail, keeping up with tasks, doesn’t listen when spoken to, forgetful, easily distracted, avoid things that take effort to perform, lose things needed for a task, often does not follow instructions

http://www.cdc.gov/ncbddd/adhd/symptom.htm

DIAGNOSE CONT.DSM-IV Criteria for ADHDB. Six or more of the following symptoms of

hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level:

Hyperactivity: Often fidgety or squirms in seat, often runs about or climbs when and where it is not appropriate, act loudly, driven (always on the go), often talks excessively.

DIAGNOSE CONT.Impulsivity blurts out answers before questions have

been finished trouble waiting one's turn. interrupts or intrudes on others Some symptoms that cause impairment

were present before age 7 years. Some impairment from the symptoms are

present in two or more settings (e.g. at school/work and at home).

There must be clear evidence of significant impairment in social, school, or work functioning.

DIAGNOSE CONT. Based on the these criteria,

three types of ADHD are identified:1. ADHD, Combined Type: if both criteria A and B are met for the past 6 months.

Tigger type-Hyperactive, restelessness, disorganized, inattention, impulsivity

DIAGNOSE CONT. 2. ADHD, Predominantly

Inattentive Type: if criterion A is met but criterion B is not met for the past six months Pooh type- Inattentive,

sluggish, slow-moving, unmotivated, daydreamer

DIAGNOSE CONT. 3. ADHD,

Predominantly Hyperactive-Impulsive Type: if Criterion B is met but Criterion A is not met for the past six months.

Rabbit Type- over focused, obsessive, argumentative

CLASSIFICATION OF ADHD developmental disorder behavior disorder disruptive behavior disorder oppositional defiant disorder conduct disorder antisocial disorder

ADHD THROUGHOUT THE LIFESPAN Preschool- Disruptive behavior, aggression

towards other children, hyperactivity, conduct problems, inattentive and overactive

Middle Childhood- Unfinished tasks (unfinished games, uncovered toothpaste), trouble with school work, criticism from parents/teachers/peers, low self esteem. Depression and conduct disorders can develop here.

ADHD THROUGHOUT THE LIFESPAN CONT. Adolescence- higher rates of anxiety,

depression, oppositional behavior, social failure, substance abuse

Adulthood- trouble at work, relationships, difficulty following directions, remembering, and concentrating, emotional and social problems

EPIDEMIOLOGY CDC estimates 4.4 million youth ages 4-17

have been diagnosed with ADHD In 2003, 2.5 million youth ages 4-17 are

currently receiving medication treatment for the disorder.

http://www.cdc.gov/ncbddd/ADHD/

PERCENT OF YOUTH 4-17 EVER DIAGNOSED WITH ATTENTION-DEFICIT/HYPERACTIVITY DISORDER: NATIONAL SURVEY OF CHILDREN'S HEALTH, 2003

http://www.cdc.gov/ncbddd/ADHD/adhdprevalence.htm

PERCENT OF YOUTH 4-17 EVER DIAGNOSED AND CURRENTLY MEDICATED FOR ATTENTION-DEFICIT/HYPERACTIVITY DISORDER: NATIONAL SURVEY OF CHILDREN'S HEALTH, 2003

http://www.cdc.gov/ncbddd/ADHD/adhdmedicated.htm

TREATMENT treatment focuses on reducing the symptoms

of ADHD and improving functioning through medications, behavioral therapies, and psycho therapy.

MEDICATIONS Most are treated with stimulant but non-

stimulants are also used Medication help to improve focus, thinking,

ability to learn and work It also reduces symptoms of hyperactivity,

impulsivity, and inattention

http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/medications.shtml

LIST OF MEDS APPROVED BY FDA

http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/medications.shtml

BEHAVIORS THERAPY Goal: change/monitor child behaviors Intervention includes: practical assistance with organizing tasks or

completing schoolwork, or working through emotionally difficult events

allow child to give oneself praise or rewards for acting in a desired way

Parents and teachers also can give positive or negative feedback for certain behaviors.

Set clear rules, chore lists, and other structured routines can help a child control his or her behavior

http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/psychotherapy.shtml

NUTRITIONAL & DIETARY THERAPIES FOR ADHD

Carbohydrate/Protein-balanced Diet Management of Food Sensitivities in ADHD

Patients Nutritional Supplementation for ADHD Mineral Deficiencies in ADHD Essential Fatty Acids May Be Deficient in ADHD Disturbances in Amino Acid Metabolism in ADHD Heavy-Metal Toxicity in ADHD

http://www.healing-arts.org/children/ADHD/treatments.htm

TIPS FOR PARENT Schedule. Keep the same routine every day, from

wake-up time to bedtime. Include time for homework, outdoor play, and indoor activities. Keep the schedule on the refrigerator or on a bulletin board in the kitchen. Write changes on the schedule as far in advance as possible.

Organize everyday items. Have a place for everything, and keep everything in its place. This includes clothing, backpacks, and toys.

Use homework and notebook organizers. Use organizers for school material and supplies. Stress to your child the importance of writing down assignments and bringing home the necessary books.

Be clear and consistent. Children with ADHD need consistent rules they can understand and follow.

Give praise or rewards when rules are followed. Children with ADHD often receive and expect criticism. Look for good behavior, and praise it.

http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/psychotherapy.shtml

NURSING CARE Expected outcomes:

Disruptive and dangerous behavior minimized or eliminated

The pt will be able to function in a structured learning environment

Parent’s will be able to cope with stress and feelings and intervene effectively

NURSING CARE CONT.Interventions:The nurse will: Teach close communication between parent,

child, and teacher and assess needs. Refer to a psychologist, counselor, social worker,

tutor Facilitate child’s achievement of more consistent

behavioral self control Promote parents’ development of coping