ADHD (best)]

Introduction
Causes
Diagnose (S&S)
Epidemiology
Treatment
Research and current study
Disease across life span
Nursing Care
Summary
References

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: 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

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

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

Delayed in frontal and temporal lobe
Accelerated maturity of the motor cortex
SPECT shows reduce circulation
Pet Scan shows a decrease glucose metabolism during activity

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

DSM-IV Criteria for ADHD
B. 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.

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.

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

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

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

developmental disorder
behavior disorder
disruptive behavior disorder
oppositional defiant disorder
conduct disorder
antisocial disorder

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.

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

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/

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

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

treatment focuses on reducing the symptoms of ADHD and improving functioning through medications, behavioral therapies, and psycho therapy.

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

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

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

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

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

NIMH
MTA – complete,
Purpose: evaluate the leading treatments for ADHD, including various forms of behavior therapy and medications
PATS - complete
The study found that low doses of the stimulant methylphenidate are safe and effective for preschoolers but requires monitoring due to side effects
http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/what-efforts-are-under-way-to-improve-treatment.shtml

Efficacy of Concerta in Treating ADHD in Mothers of Children With ADHD
- involves trial of Concerta™ methylphenidate for mothers & children with ADHD
- purpose: assess the efficacy of Concerta™ in improving adult ADHD symptoms and impairments
- The researchers hypothesize that Concerta™ will significantly decrease mothers ADHD symptoms and impairment, as well as improve observed and reported parenting
http://clinicaltrials.gov/ct2/results?term=ADHD

Study of Atomoxetine and OROS Methylphenidate to Treat Children and Adolescents Ages 6-17 With ADHD
- purpose: is to evaluate the safety, effectiveness, and tolerability of atomoxetine and OROS methylphenidate, taken together, in the treatment of ADHD in children and adolescents ages 6-17

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

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

http://www.youtube.com/watch?v=EJNu5eUJO04

(2009). ADHD Across the Lifespan. Retrieved February 15, 2009, from myADHD.com Web site: http://www.myadhd.com/adhdacrosslifespan.html
(2008). ADHD Screening Test. Retrieved February 15, 2009, from ScribD Web site: http://www.scribd.com/doc/2281389/ADHD-Screening-Test-PDF
(2007). NCP Attention Deficit / Hyperactivity Disorder ADHD . Retrieved February 15, 2009, from Nursing Care Plan Web site: http://nursingcareplan.blogspot.com/2007/05/ncp-attention-deficit-hyperactivity.html
Goodman, Gordon (2008). Bugs, Taz, and ADHD. Retrieved February 15, 2009, from You Tube Web site: http://www.youtube.com/watch?v=EJNu5eUJO04
(January 23, 2009). What Cause ADHD? Retrieved Febraury 15, 2009 from NIMH. Website: http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/what-causes-adhd.shtml
(September 20 th , s005). ADHD. Retrieved February 15, 2009 from CDC. Website: http://www.cdc.gov/ncbddd/adhd/symptom.htm
(September 20 th , s005). ADHD. Retrieved February 15, 2009 from CDC. Website: http://www.cdc.gov/ncbddd/ADHD/
(January 23, 2009). What Cause ADHD? Retrieved Febraury 15, 2009 from NIMH. Website: http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/medications.shtml
(January 23, 2009). What Cause ADHD? Retrieved Febraury 15, 2009 from NIMH. Website: http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/psychotherapy.shtml
(January 23, 2009). What Cause ADHD? Retrieved Febraury 15, 2009 from NIMH. Website: http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/psychotherapy.shtml
(February 12, 2009). Efficacy of Concerta in Treating ADHD in Mothers of Children With ADHD. Retrieved february 15, 2009 from clinicalTrial.gov. Website: http://clinicaltrials.gov/ct2/show/NCT00318981?term=ADHD&rank=4

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ADHD (best)]

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