ADHD is a common disorder affecting 3-5% of school-aged children. It is characterized by inattentiveness, hyperactivity, and impulsivity. Diagnosis involves evaluating symptoms, which must be present in multiple settings, and determining impairment. Treatment may include behavioral therapy, environmental modifications, medications like stimulants, and an IEP. Nurses play an important role in medication administration, safety, behavioral observation, advocacy, and supporting adherence to treatment plans.

1. ADD/ADHD
Tammy Marie Baker RN
Pediatric Series 2012

2. what is ADD/ADHD
Attention DEFICIT DISORDER with or with out hyperactivity
ADHD is a commons disorder often diagnosed
early in child
It affects 3-5 % of school aged children
More common in boys than Girls
Often seen in more than one child in the family
and even Parents of child

3. DSM-IV Criteria for ADHD
I. Either A or B:
A. Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is inappropriate for
developmental level:
Inattention
1. Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
2. Often has trouble keeping attention on tasks or play activities.
3. Often does not seem to listen when spoken to directly.
4. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behav
or failure to understand instructions).
5. Often has trouble organizing activities.
6. Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework
7. Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
8. Is often easily distracted.
9. Is often forgetful in daily activities.

4. DSM-IV Criteria for ADHD
A. 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:
B. Hyperactivity
1. Often fidgets with hands or feet or squirms in seat when sitting still is expected.
2. Often gets up from seat when remaining in seat is expected.
3. Often excessively runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
4. Often has trouble playing or doing leisure activities quietly.
5. Is often "on the go" or often acts as if "driven by a motor".
6. Often talks excessively.
3. Impulsivity
1. Often blurts out answers before questions have been finished.
2. Often has trouble waiting one's turn.
3. Often interrupts or intrudes on others (e.g., butts into conversations or games).

5. DSM CRITERIA CONTINUED
II. Some symptoms that cause impairment were present before age 7 years.
III. Some impairment from the symptoms is present in two or more settings (e.g. at school/work and at home).
IV. There must be clear evidence of clinically significant impairment in social, school, or work functioning.
V. The symptoms do not happen only during the course of a Pervasive Developmental Disorder, Schizophrenia, or other are not better
Psychotic Disorder. The symptoms for by another mental disorder (e.g. Mood Disorder, Anxiety Disorder,Dissociative Disorder, or a Personality
Disorder).
Based on these criteria, three types of ADHD are identified:
IA. ADHD, Combined Type: if both criteria IA and IB are met for the past 6 months
IB. ADHD, Predominantly Inattentive Type: if criterion IA is met but criterion IB is not met for the past six months
IC. ADHD, Predominantly Hyperactive-Impulsive Type: if Criterion IB is met but Criterion IA is not met for the past six months.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC,
American Psychiatric Association, 2000.

6. ADHD
Inattentiveness
1. Fails to give close attention to details or makes careless mistakes in schoolwork
2. Has difficulty keeping attention during tasks or play
3. Does not seem to listen when spoken to directly
4. Does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace
5. Has difficulty organizing tasks and activities
6. Avoids or dislikes tasks that require sustained mental effort (such as schoolwork)
7. Often loses toys, assignments, pencils, books, or tools needed for tasks or activities
8. Is easily distracted
9. Is often forgetful in daily activities

7. hyperactivity
Hyperactivity symptoms:
1.Fidgets with hands or feet or squirms in seat
2.Can not stay seated when asked to
3.Mobilizes self , Runs around or climbs in
inappropriate situations
4.FInds Quiet Play Difficult
5.Excessively verbal and always "on the go," acts as
if "driven by a motor,"

8. Impulsivity syptoms
1.Blurts out answers before questions have been completed
2.Has difficulty awaiting turn
3.Interrupts or intrudes on others
4.Butts into conversations or games

9. WHat does ADHd Look like?

10. DIAgnosis
The diagnosis is based on very specific symptoms, which must be present in more
than one setting.
6 attention or 6 hyperactivity symptoms present prior to age 7
Symptoms present in more than one environmental setting ( home, school,
church, peer relationships)
Symptoms are sever enough to cause disruption in the environmental settings
•

11. Testing for ADHD Multidisciplinary approach
Team involves Physician, Teachers, family Psychologist, psychiatrist, Physical and
occupational therapist
psychological evaluation of child/family
psychological testing of child
Behavioral Questionnaire Burke or Connors
developmental/ physical exam
Nutritional evaluation

12. Treatment options
Behavioral therapy
Social Skills classes or therapy
Environmental structure
Medications
IEP for school

13. working with ADHD children
Maintain set schedules for school , home work, meals and activities
• Avoid abrupt changes in schedules, plan changes ahead of time as children's with
ADHD do not tolerate change well
• Communicate regularly with the child's teachers, caregivers, therapist
• Minimize child's environmental distractions
• Healthy Nutritional Choices should include , nutritional variety ,plenty of fiber and
basic nutrients.
• Establish good sleep patterns with consistency in amount of sleep
• Acknowledge good behavior with Praise and positive reinforcement
• Provide clear and consistent rules for the child.
teach and instruct PCG/Teachers and Nurses

14. Medications
(Psychostimulants also known as Stimulants)
Medications used for ADHD are stimulants
Children respond to medications in a variety of ways. Each child should be evaluated and monitored closely
while on “stimulant” medications as they may have adverse reactions or medications interactions if
combined.
Medications are kept out of reach of children and administered by the PCG/SN or school nurse
Blood levels are checked to monitor toxicity, liver function and abnormalities
Notify the MD if medications reactions are suspected or adverse reactions noted such as suicidal ideations,
hallucinations, worsened behavior, insomnia, appetite loss or sever increase
Do not discontinue meds abruptly, change dose or stop meds on weekends with out consulting a physician
first. Drop in medication levels can cause abrupt behavioral changes

15. TERMinology
BIP Behavioral intervention Plan
FBA Functional Behavioral Assessment
IEP: Individual Education Plan
MDM: Manifestation Determination Meeting

16. MEDICATIONS commonly used
Methylphenidate (Ritalin,Concerta,Metadate,daytrana)
Atomoxetine : Strettara ( non stimulant)
Amphetamine-Dextroamphetamine: (Addarel)
Dexmethylphenidate (Focalin)
Dextroamphetamine ( Dexidrin, Dextrostat
LIsdexamfetamine (Vyvanse)
Combinations of Medications may also be seen
Caution and Observation should always be used when these types of medications are
combined & administered to children.Nursing observation and Assessment of childs
tolerance and behavior is essential

17. Nursing care of children with ADD/ADHD
Safety measures include:physical safety of the child secondary to impulsivity,
medication safety
Medication Administration and Education of family
Behavioral observations and recording in nursing notes; reporting to the physician
any sudden changes in affect or behavior
IEP (Individual Educational Plan) advocacy and support to the child and
Family.The nurse should be familiar with the child's IEP. Nurses are often
included in the IEP meetings.
Behavioral intervention Plan: Adhere to the behavioral guidelines set in the plan
and assist the family in implementation and adhering to the guidelines of the
plan.
The nurse should not judge the family nor the child. Behaviors are a function of
the child's disability Provide support and understanding to the family.

18. conclusion
Children with ADHD are a challenge and a Gift
Nurse’s who care for them make a difference..