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ADHD (best)]

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ADHD (best)]

  1. 2. <ul><li>Introduction </li></ul><ul><li>Causes </li></ul><ul><li>Diagnose (S&S) </li></ul><ul><li>Epidemiology </li></ul><ul><li>Treatment </li></ul><ul><li>Research and current study </li></ul><ul><li>Disease across life span </li></ul><ul><li>Nursing Care </li></ul><ul><li>Summary </li></ul><ul><li>References </li></ul>
  2. 3. <ul><li>Termed: Attention deficit, hyperactivity disorder </li></ul><ul><li>ADD is no different from ADHD but it refers to adults in the Diagnostic & Statistical Manual for Mental Disorders (DSM-IV-TR) </li></ul><ul><li>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. </li></ul>
  3. 4. <ul><li>Myth: ADHD is caused by bad parenting. </li></ul><ul><li>Myth: Children who have ADHD will eventually grow out of it. </li></ul><ul><li>Myth: ADHD is not a medical condition. </li></ul><ul><li>Fact: ADHD is a neurobehavioural disorder </li></ul><ul><li>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. </li></ul><ul><li>Fact: ADHD is a biological brain based condition officially recognized by leading medical experts and institutions </li></ul>
  4. 5. <ul><li>Specific cause is unknown </li></ul><ul><li>Twin studies showed that 75% of ADHD cases are genetically inherited </li></ul><ul><li>Twin studies also suggested that 9-20% is also due to environmental factors </li></ul><ul><ul><li>Pregnancy: smoking, alcohol, and premature birth </li></ul></ul><ul><li>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 </li></ul>
  5. 6. <ul><li>Dopamine: research study suggests that various genes affect the neurotransmitter dopamine: </li></ul><ul><ul><li>Dopamine activation is a reward for the brain </li></ul></ul><ul><ul><li>ADHD individuals dopamine receptors are not as efficient as a normal person’s therefore they have a lower dopamine level </li></ul></ul>
  6. 7. <ul><li>Delayed in frontal and temporal lobe </li></ul><ul><li>Accelerated maturity of the motor cortex </li></ul><ul><li>SPECT shows reduce circulation </li></ul><ul><li>Pet Scan shows a decrease glucose metabolism during activity </li></ul>
  7. 9. <ul><li>DSM-IV Criteria for ADHD I. Either A or B: </li></ul><ul><li>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: </li></ul><ul><li>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 </li></ul>
  8. 10. <ul><li>DSM-IV Criteria for ADHD </li></ul><ul><li>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: </li></ul><ul><li>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. </li></ul>
  9. 11. <ul><li>Impulsivity </li></ul><ul><li>blurts out answers before questions have been finished </li></ul><ul><li>trouble waiting one's turn. </li></ul><ul><li>interrupts or intrudes on others </li></ul><ul><li>Some symptoms that cause impairment were present before age 7 years. </li></ul><ul><li>Some impairment from the symptoms are present in two or more settings (e.g. at school/work and at home). </li></ul><ul><li>There must be clear evidence of significant impairment in social, school, or work functioning. </li></ul>
  10. 13. <ul><li>Based on the these criteria, three types of ADHD are identified: </li></ul><ul><li>1. ADHD, Combined Type : if both criteria A and B are met for the past 6 months. </li></ul><ul><ul><li>Tigger type-Hyperactive, restelessness, disorganized, inattention, impulsivity </li></ul></ul>
  11. 14. <ul><li>2. ADHD, Predominantly Inattentive Type : if criterion A is met but criterion B is not met for the past six months </li></ul><ul><ul><li>Pooh type- Inattentive, sluggish, slow-moving, unmotivated, daydreamer </li></ul></ul>
  12. 15. <ul><li>3. ADHD, Predominantly Hyperactive-Impulsive Type : if Criterion B is met but Criterion A is not met for the past six months. </li></ul><ul><li>Rabbit Type- over focused, obsessive, argumentative </li></ul>
  13. 16. <ul><li>developmental disorder </li></ul><ul><li>behavior disorder </li></ul><ul><li>disruptive behavior disorder </li></ul><ul><li>oppositional defiant disorder </li></ul><ul><li>conduct disorder </li></ul><ul><li>antisocial disorder </li></ul>
  14. 17. <ul><li>Preschool- Disruptive behavior, aggression towards other children, hyperactivity, conduct problems, inattentive and overactive </li></ul><ul><li>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. </li></ul>
  15. 18. <ul><li>Adolescence- higher rates of anxiety, depression, oppositional behavior, social failure, substance abuse </li></ul><ul><li>Adulthood- trouble at work, relationships, difficulty following directions, remembering, and concentrating, emotional and social problems </li></ul>
  16. 19. <ul><li>CDC estimates 4.4 million youth ages 4-17 have been diagnosed with ADHD </li></ul><ul><li>In 2003, 2.5 million youth ages 4-17 are currently receiving medication treatment for the disorder. </li></ul>
  17. 20.
  18. 21.
  19. 22. <ul><li>treatment focuses on reducing the symptoms of ADHD and improving functioning through medications, behavioral therapies, and psycho therapy. </li></ul>
  20. 23. <ul><li>Most are treated with stimulant but non-stimulants are also used </li></ul><ul><li>Medication help to improve focus, thinking, ability to learn and work </li></ul><ul><li>It also reduces symptoms of hyperactivity, impulsivity, and inattention </li></ul>
  21. 24.
  22. 25. <ul><li>Goal: change/monitor child behaviors </li></ul><ul><li>Intervention includes: </li></ul><ul><li>practical assistance with organizing tasks or completing schoolwork, or working through emotionally difficult events </li></ul><ul><li>allow child to give oneself praise or rewards for acting in a desired way </li></ul><ul><li>Parents and teachers also can give positive or negative feedback for certain behaviors. </li></ul><ul><li>Set clear rules, chore lists, and other structured routines can help a child control his or her behavior </li></ul>
  23. 26. <ul><li>Carbohydrate/Protein-balanced Diet </li></ul><ul><li>Management of Food Sensitivities in ADHD Patients </li></ul><ul><li>Nutritional Supplementation for ADHD </li></ul><ul><li>Mineral Deficiencies in ADHD </li></ul><ul><li>Essential Fatty Acids May Be Deficient in ADHD </li></ul><ul><li>Disturbances in Amino Acid Metabolism in ADHD </li></ul><ul><li>Heavy-Metal Toxicity in ADHD </li></ul>
  24. 27. <ul><li>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. </li></ul><ul><li>Organize everyday items . Have a place for everything, and keep everything in its place. This includes clothing, backpacks, and toys. </li></ul><ul><li>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. </li></ul><ul><li>Be clear and consistent . Children with ADHD need consistent rules they can understand and follow. </li></ul><ul><li>Give praise or rewards when rules are followed . Children with ADHD often receive and expect criticism. Look for good behavior, and praise it. </li></ul>
  25. 28. <ul><li>NIMH </li></ul><ul><li>MTA – complete, </li></ul><ul><li>Purpose: evaluate the leading treatments for ADHD, including various forms of behavior therapy and medications </li></ul><ul><li>PATS - complete </li></ul><ul><li>The study found that low doses of the stimulant methylphenidate are safe and effective for preschoolers but requires monitoring due to side effects </li></ul>
  26. 29. <ul><li>Efficacy of Concerta in Treating ADHD in Mothers of Children With ADHD </li></ul><ul><li>- involves trial of Concerta™ methylphenidate for mothers & children with ADHD </li></ul><ul><li>- purpose: assess the efficacy of Concerta™ in improving adult ADHD symptoms and impairments </li></ul><ul><li>- The researchers hypothesize that Concerta™ will significantly decrease mothers ADHD symptoms and impairment, as well as improve observed and reported parenting </li></ul>
  27. 30. <ul><li>Study of Atomoxetine and OROS Methylphenidate to Treat Children and Adolescents Ages 6-17 With ADHD </li></ul><ul><li>- 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 </li></ul>
  28. 31. <ul><li>Expected outcomes: </li></ul><ul><ul><li>Disruptive and dangerous behavior minimized or eliminated </li></ul></ul><ul><ul><li>The pt will be able to function in a structured learning environment </li></ul></ul><ul><ul><li>Parent’s will be able to cope with stress and feelings and intervene effectively </li></ul></ul>
  29. 32. <ul><ul><li>Interventions: </li></ul></ul><ul><ul><li>The nurse will: </li></ul></ul><ul><ul><li>Teach close communication between parent, child, and teacher and assess needs. </li></ul></ul><ul><ul><li>Refer to a psychologist, counselor, social worker, tutor </li></ul></ul><ul><ul><li>Facilitate child’s achievement of more consistent behavioral self control </li></ul></ul><ul><ul><li>Promote parents’ development of coping </li></ul></ul>
  30. 33. <ul><li> </li></ul>
  31. 34. <ul><li>(2009). ADHD Across the Lifespan. Retrieved February 15, 2009, from Web site: </li></ul><ul><li>(2008). ADHD Screening Test. Retrieved February 15, 2009, from ScribD Web site: </li></ul><ul><li>(2007). NCP Attention Deficit / Hyperactivity Disorder ADHD . Retrieved February 15, 2009, from Nursing Care Plan Web site: </li></ul><ul><li>Goodman, Gordon (2008). Bugs, Taz, and ADHD. Retrieved February 15, 2009, from You Tube Web site: </li></ul><ul><li>(January 23, 2009). What Cause ADHD? Retrieved Febraury 15, 2009 from NIMH. Website: </li></ul><ul><li>(September 20 th , s005). ADHD. Retrieved February 15, 2009 from CDC. Website: </li></ul><ul><li>(September 20 th , s005). ADHD. Retrieved February 15, 2009 from CDC. Website: </li></ul><ul><li>(January 23, 2009). What Cause ADHD? Retrieved Febraury 15, 2009 from NIMH. Website: </li></ul><ul><li>(January 23, 2009). What Cause ADHD? Retrieved Febraury 15, 2009 from NIMH. Website: </li></ul><ul><li>(January 23, 2009). What Cause ADHD? Retrieved Febraury 15, 2009 from NIMH. Website: </li></ul><ul><li> </li></ul><ul><li>(February 12, 2009). Efficacy of Concerta in Treating ADHD in Mothers of Children With ADHD. Retrieved february 15, 2009 from Website: </li></ul>