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Attention-Deficit Hyperactivity Disorder

4 min read

References:

  1. Course Module

ADHD is a neurodevelopmental type mental disorder characterized by difficulty in paying attention, excessive activity, and acting without regards to consequences, which are otherwise not appropriate for a person’s age i.e. hyperactivity, inattentiveness, distractibility and impulsivity. This condition is often identified and diagnosed at the beginning of preschool. Diagnosis is differentiated from other potentially similar disorders such as bipolar disorder or behaviorally acting out through its consistency across almost all times (behavior is displayed every day) and situations.

  • Incidence: more common among boys, starting before the age of 12 years and with symptoms that persist for longer than 6 months.
  • Risk Factors: poor familial socioeconomic status, harmony, treatment (neglect, abuse), or parental deprivation; low birth weight; family history of ADHD
  • Symptoms (mn. ADHD)
    • Academic Performance is poor
    • Development of Relationships is strained; behavior is disruptive and intrusive at home and during conversation, causing friction with family and peers.
    • Hyperactivity and Impulsivity: restlessness (can’t sit still, fidgets), excessive talking, running, and climbing, and being interruptive in conversation.
    • Difficulty sustaining attention and concentration
      • Not appearing to listen, missing details, easily distracted
      • Makes careless mistakes in school works, avoids mentally difficult tasks
      • Unable to organize and misplaces objects
      • Attention span can range from 2 to 3 minutes (mild) to 2 to 3 seconds (severe)

Treatment

  1. Psychopharmacology (mn. CARDS)
    • Cylert (Pemoline): a stimulant, commonly causing insomnia, anorexia, weight loss, or failure to gain weight. It is hepatotoxic, and therefore the last drug to be prescribed.
    • Adderal (Amphetamine) is commonly used for ADHD cases.
    • Ritalin (Methyphenidine) is the most common drug used, effective in 70% to 80% ADHD cases.
    • Dexedrine (Dextroamphetamine): a stimulant, commonly causing insomnia, anorexia, weight loss, irritability, and risk for self-injury.
    • Strattera (Atomoxetine): a non-stimulant antidepressant (SSRI) drug. May cause anorexia, nausea and vomiting, fatigability, and abdominal distress.
  2. Other Drugs
    • Tricyclic Antidepressants
    • Alpha-2 Agonists: Clonidine and Guanfacine
    • Traditional antipsychotic drugs may be used to manage severe impulsiveness

Nursing Assessment

  1. Short attention span
  2. High level of distractibility
  3. Labile moods
  4. Low frustration tolerance
  5. Inability to complete tasks
  6. Inability to sit still or fidgeting
  7. Excessive talking
  8. Inability to follow directions

Nursing Interventions

  1. Ensure safety for the client and others: stop unsafe behaviors, provide supervision, and give clear instructions about acceptable and unacceptable behavior.
  2. Improve role performance: Allow the client to accomplish tasks easier.
    • Modifying the environment: Identify and restrict stimuli that may aggravate the client. Interact with a one-to-one basis, and gradually increasing environmental stimuli may be implemented.
    • Gaining the child’s full attention: call the client’s name, establish eye contact, and allow the client to repeat given instructions.
    • Simplifying instructions and breaking complex tasks down into simpler tasks. State expectations for the task completion, and initially assist the client in the tasks. Gradually decrease assistance to prompting or reminding the client on performing tasks. Additionally, asking the client sequencing questions (“what happens next?”) can help with logical thought and decrease tangentiality. Reminders may also then be gradually decreased.
    • Allowing for breaks, especially for sedentary tasks where the client may feel restless.
    • Crucially, providing positive feedback for meeting expectations through each step and coming closer to completion conditions the client to perform.
  3. Structured daily routine: establish a daily schedule and minimize changes. Children with ADHD do not readily adjust to changes and may fail to meet expectations for day-to-day tasks if they are done arbitrarily.
  4. Client and family education and support:
    • Instruct the patients for implementing the same steps for improving role performance within the client’s home environment.
    • Listen to the parents’ feelings about frustration, anger, and guilt. They may blame themselves for the child’s problems. They should hear that neither they nor their child are at fault. Give the parents an opportunity to attend a support group.
    • Counsel the parents on giving the child positive feedback, focusing on the child’s strengths, and on how to build the child’s self-esteem, which may be impacted due to their behavioral tendencies. This may be done, for example, by counting the number of times the parents praise or criticize the child on a day-to-day basis.

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