Attention-Deficit Hyperactivity

Disorder

ANA ROWENA A.PERERA R.N.M.A.N

PREVALENCE
● estimated 3% to 5% of all school-aged children
● ratio: 3.5:1 (male-female)
● girls tend to have more inattentive symptoms and boys more of
impulsive symptoms

ETIOLOGY
● Genetics - run in the families
● Minimal brain damage
● Neurotransmitter/Neuroanatomical Hypothesis
● Child/Family Factors (chaotic, difficult temperament)
ONSET and CLINICAL COURSE
● Before 7 years old
● Average onset: 3 years old
● Remission prior to 12 years old
● Comorbid disorders:
➢Learning Disorders
➢Substance abuse
➢Anxiety, Affective Disorder
● 70-80% continue to adolescence, 65% into adulthood
● Adult outcome:
➢ASPD
➢poor educational and employment performance
 a person wanders off task, lacks persistence,
Inattention has difficulty sustaining focus, and is
disorganized
DIAGNOSIS
a person seems to move about constantly,
Hyperactivity including in situations in which it is not
appropriate; or excessively fidgets, taps, or
talks

a person makes hasty actions that occur in the

Impulsivity moment without first thinking about them and
that may have a high potential for harm
 Inattentive Type
3 of the following symptoms:
● Difficulty following instructions
● Difficulty keeping attention on work or play
activities at school and at home
● Loses things needed for school, at home
● Appears not to listen
● Doesn't pay close attention to details
● Seems disorganized
● Trouble with tasks that require planning
ahead
● Forgets things
● Is easily distracted
 Impulsive Type
● Often acts before thinking
● Shifts excessively from one activity to
another
● Has difficulty organizing work
● Needs frequent division
● Frequently calls out to class
● Difficulty waiting turn in games or group
activities
 Hyperactive Type
2 of the following symptoms:

● Runs or climbs inappropriately

● Blurts out answers
● Interrupts people
● Can't stay in seat
● Talks too much
● Is always on the go
 Pharmacological
TREATMENT ● Psychostimulants
❏Methyphenidate (Ritalin)
❏Pemoline (Cylert)
❏Dextroamphetamine (Dexedrine)

Common side effects:

➔ insomnia
➔ loss of appetite
➔ weight loss or failure to gain weight
 Non-Pharmacological
TREATMENT ● Multi-modal treatment planning
● Parent/child education
● Parent management training
● Family/individual psychotherapy
● Specialized education
● School/teacher education
● Social skills training
● Exercise routines
NURSING INTERVENTION GOAL: To keep child from harming self or others
● Assist to recognize when he/she feels angry (teach to
accept feelings of anger)
● Teach appropriate ways of expressing anger
● Redirect violent behaviors-physical outlets
● Confront child: withdraw attention if with
manipulative or exploitative interactions
● Use time out, isolation room and restraints only
when other interventions are unsuccessful
TNURSING INTERVENTION GOAL: To encourage age-appropriate, socially
acceptable coping skills

● Provide large motor skills activities

● Provide frequent, nutritious snacks - “eat on the run”
NURSING INTERVENTION GOAL: To decrease anxiety and increase self-
esteem

● Encourage to seek out staff to discuss true feelings

● Offer support during times of increased anxiety

(ensure physical and psychological anxiety)
NURSING INTERVENTION GOAL: To administer prescribed medication
● Ritalin is given; usually discontinued when the child
enters adolescence

● Prolonged administration may produce a temporary

suppression of normal weight gain

● Administer in the morning and 30-35 minutes before

meals
● Work towards COPE not CURE

● Monitor with behavioral checklists

REFERENCES:
Shives, Psychiatric Nursing

Videbeck. S. , Psychiatric and Mental Health Nursing

THANK YOU