Attention Deficit Hyperactivity Disorder (ADHD)
Included In This Lesson
Study Tools For Attention Deficit Hyperactivity Disorder (ADHD)
Outline
Overview
- Developmental condition with varying degrees of inattention, impulsiveness and hyperactivity
- Early diagnosis and intervention is key
- To prevent repeated exposure to negative feedback from negatively affecting development and self-image.
Nursing Points
General
- Diagnosis
- Criteria established by DSM-V (Diagnostic and Statistical Manual of Mental Disorders)
- Multidisciplinary evaluation needed
- Behavior assessed in variety of settings (home, school, play)
- Symptoms present 6 months or more
- Variables to consider
- Learning disability present?
- Hearing or vision problem?
- Abuse/neglect
- Lead poisoning
- Children with ADHD are at increased risk for
- Depression
- Anxiety disorders
- Speech and language delays
- Learning disabilities
Assessment
**All children will display the following behaviours to some degree. In ADHD symptoms are developmentally inappropriate and negatively impacting life.
- Inattention and Distractibility
- Appears to not listen
- Does not complete tasks
- Often loses things
- Forgetful in daily activities
- Makes careless mistakes
- Hyperactivity & Impulsiveness
- Fidgets (tapping, squirming)
- Difficulty playing quietly
- Excessive talking
- Interrupting/Blurting out answers
Therapeutic Management
- Behavioral Therapy
- Parent education
- Positive reinforcement
- Reward systems
- Age appropriate consequences
- Time out
- Positive reinforcement
- Important to collaborate with school and other caregivers
- Parent education
- Medications
- Doses are based on effectiveness not weight
- Exception – Atomoxetine (Strattera)
- Stimulants
- Methylphenidate hydrochloride
- Dextroamphetamine
- Side effects:
- Appetite loss
- Abdominal pain
- Sleep disturbances
- Headaches
- Non-stimulant
- Norepinephrine reuptake inhibitors
- Atomoxetine (Strattera)
- Adrenergic agonists
- Norepinephrine reuptake inhibitors
- Doses are based on effectiveness not weight
- Nursing care
- Coordinate interdisciplinary care and long-term management
- Monitor for:
- Weight loss
- Psychological dependance on medications
- Depression
Nursing Concepts
- Human Development
- Coping
- Health Promotion
Patient Education
- Administering stimulants
- Give with meals or after meals to avoid appetite suppression
- Administer doses early in the day to avoid sleeplessness
- Keep drugs safely stored to prevent accidental ingestion with younger children and abuse with older children and adolescents.
ADPIE Related Lessons
Related Nursing Process (ADPIE) Lessons for Attention Deficit Hyperactivity Disorder (ADHD)
Transcript
Hey everybody, in this lesson we are going to be talking about Attention Deficit Hyperactivity Disorder or ADHD. It used to be called ADD but now it’s pretty much exclusively called ADHD.
ADHD is a developmental disorder that usually presents with degrees of the following: inattention, impulsivity and hyperactivity.
Diagnosis can be difficult because kids need to be assessed in a variety of settings by a variety of professionals. Diagnostic criteria is outlined in the DSM-V, which is the Diagnostic and Statistical Manual of Mental Disorders. The DSM-V gives 3 different categories for the diagnosis 1) ADHD that is mostly inattentive 2) ADHD that is mostly hyperactive/impulsive and 3) combined.
One very important thing to know is that all kids are going to experience inattention and impulsivity and hyperactivity to some degree, but with ADHD, they are negatively impacting their life. And for diagnosis, they must have symptoms for 6 months or more.
One thing to think about with this diagnosis is the potential for stigmas and stereotyping around it. There’s been this feeling from society at large that kids with ADHD just need to be better disciplined. It’s important to let parents know that this is not the case. ADHD is a complex problem and a lot of factors contribute to it.
Like I said, diagnosis is an extensive process and there is a very long list of symptoms in the DSM-V. I’ve just highlighted key ones here. Under the category of inattention, they child may appear not to listen, they struggle to complete tasks, they lose things frequently, are forgetful during daily activities and may make careless mistakes.
Impulsivity and hyperactivity may present as fidgeting (tapping and squirming), difficulty playing quietly, excessive/loud talking and frequently interrupting others.
Medications are the first-line for treatment. The two categories to be aware of are stimulants and non-stimulants.
Stimulants that may be prescribed are methylphenidate and dextroamphetamine.
Non-stimulants that may be prescribed are SNRI’s like atomoxetine (or strattera) and antidepressants.
Behavioural therapy may be beneficial as well because it may help break the negative feedback cycle that these kids often find themselves in. The sense they they are constantly in trouble adds to their challenges so the idea is to teach parents and educators how to communicate positively, use positive reinforcement and implement structure and discipline.
A lot of our nursing care for these kids is focused coordinating care with schools and educating parents on how to best administer these meds and what side effects to monitor for. So, let’s talk a bit more about that.
One of the most important parts of managing ADHD is compliance. One of the best ways to make sure that kids take their meds is to prescribe the long-acting form of the stimulant. This keeps them from having to take medications several times throughout the day, which is tough to do when they are at school.
Stimulants also have a lot of side effects, like appetite and weight loss, sleep disturbances and anxiety. Parents need to know to monitor for these and how to minimize them. It’s recommended to give the meds with meals or after meals, rather than before and to administer early in the day so it doesn’t affect sleep as much.
Some parents may be really worried that their kids will become addicted to the stimulants. Inform them that this is unlikely, but it is important to store the meds safely so other kids in the house can’t easily get into them.
Your primary nursing concepts are human development, coping and health promotion.
Okay, lets recap your major learning points for this lesson. ADHD is a developmental disorder that usually presents with inattention, impulsivity and hyperactivity.
Diagnosis is guided by the DSM-V and should be approached by a multidisciplinary team. Symptoms should be seen in all environments, not just at home, they should be present for 6 months or more and they must be negatively affecting the child’s life.
Symptoms are varied, but usually include difficulty focusing and completing tasks, fidgeting and hyperactive behaviour
Treatment is a combination of medications and behavioural therapy
The most commonly used medications are stimulants. Side effects of stimulants are decreased appetite, sleep disturbances and anxiety. Make sure parents know to monitor their child for weight loss and how to minimize the side effects. Behavioural therapy focuses on breaking the negative cycle with positive parenting and having structure.
That’s it for our lesson on Attention Deficit Disorder. Make sure you check out all the resources attached to this lesson. Now, go out and be your best self today. Happy Nursing!
Monalisa’s Study Plan
Concepts Covered:
- Community Health Overview
- Circulatory System
- Urinary System
- Communication
- Prenatal Concepts
- Test Taking Strategies
- Respiratory Disorders
- EENT Disorders
- Developmental Theories
- Legal and Ethical Issues
- Prefixes
- Suffixes
- Acute & Chronic Renal Disorders
- Disorders of the Adrenal Gland
- Preoperative Nursing
- Integumentary Disorders
- Integumentary Disorders
- Prioritization
- Bipolar Disorders
- Disorders of the Posterior Pituitary Gland
- Hematologic Disorders
- Immunological Disorders
- Renal Disorders
- Childhood Growth and Development
- Labor Complications
- Upper GI Disorders
- Medication Administration
- Developmental Considerations
- Adulthood Growth and Development
- Disorders of Pancreas
- Musculoskeletal Disorders
- Musculoskeletal Trauma
- Disorders of the Thyroid & Parathyroid Glands
- Integumentary Important Points
- Pregnancy Risks
- Urinary Disorders
- Cardiac Disorders
- Learning Pharmacology
- Documentation and Communication
- Anxiety Disorders
- Basic
- Factors Influencing Community Health
- Prenatal and Neonatal Growth and Development
- Lower GI Disorders
- Eating Disorders
- Trauma-Stress Disorders
- Microbiology
- Oncology Disorders
- Somatoform Disorders
- Fundamentals of Emergency Nursing
- Dosage Calculations
- Concepts of Population Health
- Understanding Society
- Depressive Disorders
- Personality Disorders
- Cognitive Disorders
- Substance Abuse Disorders
- Psychological Emergencies
- Hematologic Disorders
- Liver & Gallbladder Disorders
- Emergency Care of the Cardiac Patient
- Female Reproductive Disorders
- Delegation
- Vascular Disorders
- Oncologic Disorders
- Postpartum Complications
- Fetal Development
- Endocrine and Metabolic Disorders
- Basics of NCLEX
- Shock
- Studying
- Concepts of Mental Health
- Labor and Delivery
- Gastrointestinal Disorders
- Health & Stress
- Neurological Emergencies
- EENT Disorders
- Emotions and Motivation
- Intraoperative Nursing
- Digestive System
- Central Nervous System Disorders – Brain
- Tissues and Glands
- Postpartum Care
- Cardiovascular Disorders
- Newborn Care
- Renal and Urinary Disorders
- Newborn Complications
- Neurologic and Cognitive Disorders
- Musculoskeletal Disorders
- Infectious Disease Disorders
- Nervous System
- Respiratory System
- Behavior
- Terminology
- Respiratory Emergencies
- Peripheral Nervous System Disorders
- Proteins
- Noninfectious Respiratory Disorder
- Basics of Human Biology
- Neurological Trauma
- Concepts of Pharmacology
- Statistics
- Emergency Care of the Neurological Patient
- Basics of Sociology
- Central Nervous System Disorders – Spinal Cord
- Infectious Respiratory Disorder
- Psychotic Disorders
- Emergency Care of the Trauma Patient