11.07 Attention Deficit Hyperactivity Disorder (ADHD)

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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!
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