Improving the Quality of Care in Children with Attention-Deficit Hyperactivity Disorder

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Improving the Quality of Care in Children with Attention-Deficit Hyperactivity Disorder

  1. 1. Attention-Deficit Hyperactivity Disorder in Children Cassandra Rose and Julia Springer Nursing Care of Child and Adolescents
  2. 2. <ul><li>Exact etiology is unknown </li></ul><ul><li>Believed to be an alteration in </li></ul><ul><li>dopamine and norepinephrine </li></ul><ul><ul><li>The following home video is of a child who was diagnosed at the age of 8 with ADHD. </li></ul></ul><ul><ul><li>He is 2 years old in this video. </li></ul></ul>
  3. 4. <ul><li>All age groups can be affected </li></ul><ul><li>Children can be diagnosed as earlier as age 3 </li></ul><ul><li>The average age of diagnosis is between 8 to 9 years old </li></ul><ul><li>Causes impairment in two situations (home and school) </li></ul><ul><li>- Present for at least six months </li></ul><ul><li>- Inappropriate for child’s age </li></ul><ul><li>Six inattention symptoms and/or six hyperactive-impulsive symptoms required for diagnosis </li></ul><ul><ul><ul><li>- The following is a list of signs and symptoms </li></ul></ul></ul>
  4. 5. <ul><li>Inattention includes: </li></ul><ul><ul><li>- careless mistakes in schoolwork or other activities </li></ul></ul><ul><ul><li>- failure to follow instructions or finish schoolwork, chores, or tasks </li></ul></ul><ul><ul><li>- difficulty organizing tasks and activities </li></ul></ul><ul><ul><li>- easily distracted </li></ul></ul><ul><li>Hyperactivity includes: </li></ul><ul><ul><ul><li>- fidgeting with hands or feet </li></ul></ul></ul><ul><ul><ul><li>- difficulty engaging in activities quietly </li></ul></ul></ul><ul><ul><ul><li>- talks excessively </li></ul></ul></ul><ul><ul><ul><li>constantly moving- even when seated </li></ul></ul></ul><ul><li>Impulsivity includes: </li></ul><ul><ul><ul><li>- blurting out answers before questions are asked </li></ul></ul></ul><ul><ul><ul><li>- difficulty waiting turn </li></ul></ul></ul><ul><ul><ul><li>- interrupts others in conversations or games </li></ul></ul></ul>
  5. 6. <ul><li>“ Stimulant therapy has been demonstrated to reduce core ADHD symptoms of impulsivity and hyperactivity and to maximize more desired functions such as improving interpersonal skills and academic performance and decreasing disruptive behaviors” (Rabbani and Alexander, 2009). </li></ul><ul><li>Stimulants include: </li></ul><ul><ul><li>- dextroamphetamine (Dexadrine) </li></ul></ul><ul><ul><li>- methylphenidate (Ritalin; Concerta) </li></ul></ul><ul><ul><li>- dexmethylphenidate (Focalin) </li></ul></ul><ul><ul><li>- Adderall </li></ul></ul>
  6. 7. <ul><li>Other medications: </li></ul><ul><ul><li>SNRI: </li></ul></ul><ul><ul><ul><li>- atomoxetine (Strattera) </li></ul></ul></ul><ul><ul><li>Antidepressants: </li></ul></ul><ul><ul><ul><li>- buproprion (Wellbutrin) </li></ul></ul></ul><ul><ul><ul><li>- desipramine (Norpramin) </li></ul></ul></ul><ul><ul><ul><li>- nortriptyline (Pamelor) </li></ul></ul></ul><ul><ul><ul><li>- imipramine (Tofranil) </li></ul></ul></ul><ul><li>Therapeutic Effects of SNRI </li></ul><ul><ul><li>Inhibit reuptake of norepinephrine </li></ul></ul>
  7. 8. <ul><li>Potentially addictive </li></ul><ul><li>Long-term use can lead to cardiovascular, digestive, endocrine, neurologic, and psychiatric side effects </li></ul><ul><li>Side effects include: </li></ul><ul><ul><li>- insomnia </li></ul></ul><ul><ul><li>- anorexia </li></ul></ul><ul><ul><li>- weight loss </li></ul></ul><ul><ul><li>- tachycardia </li></ul></ul><ul><ul><li>- temporary decrease in the rate of growth </li></ul></ul><ul><li>Interactions: </li></ul><ul><ul><li>- over-the-counter medications that contain sympathomimetic agents </li></ul></ul>
  8. 9. <ul><li>Maintain diet </li></ul><ul><li>Daily routine/Activities of daily living </li></ul><ul><li>Medication compliance </li></ul>
  9. 10. <ul><ul><li>Parent’s Experiences and Feelings </li></ul></ul><ul><li>- Medication use is controversial. </li></ul><ul><li>- Many parents feel that medicating their children is not a way to deal with the symptoms of ADHD or that the medication will change the child’s personality. </li></ul><ul><li>- It is important for health care professionals to educate parents about medication and any alternative treatments if the parents are against a medication therapy. </li></ul>
  10. 11. (2009). Diet and attention deficit hyperactivity disorder. Harvard Mental Health Letter , 25 (12), 4-5. Retrieved from Academic Search Premier Database. Child with ADHD. Retrieved November 30, 2009, from: http://www.free-pressrelease.com/members/members_pic/200811/img/1227544921.jpg. Child with ADHD. Retrieved November 30, 2009, from: http://neuronarrative.files.wordpress.com/2008/12/ ritalin-sr-20mg-full.jpg. Jackson, D., & Peters, K. (2008). Use of drug therapy in children with attention deficit hyperactivity disorder (ADHD): maternal views and experiences. Journal of Clinical Nursing , 17 (20), 2725-2732. Kyle, T., (2008). Essentials of Pediatric Nursing, Philadelphia: Lippincott, Williams & Wilkins Rabbani, A., & Alexander, G. (2009). Impact of family structure on stimulant use among children with attention-deficit/hyperactivity disorder. Health Services Research , 44 (6), 2060-2078. Salmeron, P. (2009). Childhood and adolescent attention-deficit hyperactivity disorder: diagnosis, clinical practice guidelines, and social implications. Journal of the American Academy of Nurse Practitioners , 21 (9), 488-497. Stroh, J., Frankenberger, W., Cornell-Swanson, L., Wood, C., & Pahl, S. (2008). The use of stimulant medication and behavioral interventions for the treatment of attention deficit hyperactivity disorder: a survey of parents’ knowledge, attitudes, and experiences. Journal of Child & Family Studies , 17 (3), 385-401. Thorell, L., & Rydell, A. (2008). Behaviour problems and social competence deficits associated with symptoms of attention-deficit/hyperactivity disorder: effects of age and gender. Child: Care, Health & Development , 34 (5), 584-595. Townsend, M.C. (2008). Essentials of psychiatric mental health nursing . Philadelphia: F.A. Davis Company. Vlam, S. (2006). Attention-deficit/hyperactivity disorder: diagnostic assessment methods used by advanced practice registered nurses. Pediatric Nursing , 32 (1), 18-24. Retrieved from Academic Search Premier Database.

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