Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. It affects approximately 9% of primary school children globally, though prevalence varies by country. Boys are four times more likely to be diagnosed than girls. ADHD has been linked to genetic and environmental factors and often co-occurs with other disorders. Treatment involves medication, behavioral therapies, educational support, and nursing interventions to create a structured environment and reinforce positive behaviors. Careful diagnosis and ongoing follow-up care are important to properly manage the condition.

1. PRESENTATION BY:
Ishfaq
Ahmad

2. TOPIC : ATTENTION DEFICIT HYPERACTIVITY
DISORDER
SUB TOPICS :
Introduction Diagnosis
Definition Differential Diagnosis
Characteristics Treatment
Epidemology Nursing Interventions
Etiology Follow Up
Types
Clinical Features

3. INTRODUCTION
• Attention deficit hyperactivity disorder (ADHD) is a condition that makes
it difficult for children to pay attention or control their behavior.
• ADHD often co occurs with other emotional,behavioural,launguage and
learning disorders.
• The Syndrome was First discovered by Heinrich Hoff in 1854.

4. DEFINITION
• Attention deficit hyperactivity disorder is a neurodevelopmental disorder
in children characterised by persistent pattern of inattention and/or
hyperactivity.

5. CHARACTERISTICS
• Neurobiological disorder.
• Marked by developmentally inappropriate inattention, impulsivity, and, in
some cases, hyperactivity.
• May progress to Conduct disorder.

6. EPIDEMIOLOGY
• A prevalence of 9 % was found among primary school children globally
,although rates vary considerably from country to country.
• The prevalence rate in adolescent samples is 2-6 %.
• ADHD is 4 times more common in boys than in girls.

7. ETIOLOGY
. Genetic Factors
. Genes e.g DAT1,DRD4,LPHN3.
. Monozygotic > Dizygotic
. Parents with ADHD have > 50% chance of having a child with ADHD.
. Siblings of Hyperactivity children have about twice the risk of having the disorder.
. Biochemical Theory
. A deficit of Dopamine and Norepinephrine has been attributed in the overactivity seen in
ADHD.

8. ETIOLOGY CONT...
. Pre, Peri and Postnatal factors
. Toxic Exposure to lead , Mechanical Insult, smoking and alcohol use.
. Prematurity, Fetal distress, Prolonged labor, Low APGAR score, perinatal asphyxia.
. Postnatal infections, CNS abnormalities.

9. TYPES
• 1) Predominantly Inattentive type
• 2) Predominantly hyperactive–impulsive type
• 3) Combined type

10. 1) INATTENTIVE TYPE
9 Symptoms
• 1. Fails close attention
• 2. Trouble holding attention
• 3. Not seem to listen
• 4. Not follow through on instructions
• 5. Trouble organizing
• 6. Avoids tasks that require mental effort
• 7. Loses things fir tasks and activities
• 8. Easily distracted
• 9. Forgetful in daily activities

11. 2) IMPULSIVE / HYPERACTIVE TYPE
9 Symptoms
1.Trouble waiting for their turn
2. Interrupts or intrudes on others
3. Often blurts out an answer
4. Fidgets with or taps hands or feet
5. Leaves a seat
6. Runs about or climbs
7. ‘ Driven by a motor’
8. Talks Excessively
9. Unable to play quietly

12. CLINICAL MANIFESTATIONS
• Sensitive to stimuli, easily upset by noise, light, temperature etc.
• General coordination deficit.
• Failure to finish tasks.
• Short attention.
• Memory and thinking deficit.

13. DIAGNOSIS
• Careful and complete history that includes;
. History of presenting problems.
. Growth and development.
. Pregnancy complications.
. Family history.
• A psychiatric evaluation.
• Detailed perenatal history e.g maternal smoking,alcohol or illicit drug use.
• School Reports etc.
• Laboratory findings.

14. DIFFERENTIAL DIAGNOSIS
• Anxiety disorder
• Depression
• Oppositional defiant disorder(ODD)
• Conduct disorder

15. TRATMENT GOALS
• A child specific,individualised treatment programme should be developed for children.
• A goal of maximizing function to
. Improve relationship and performance at school,
. Decrease disruptive behaviours,
. Promote safety,
. Increase independence and
. Improve self esteem.

16. TREATMENT OPTIONS
• Medications
• Behaviour and psychotherapies
• Educational techniques

17. TREATMENT
• Pharmacotherapy.
• Stimulants:
.Methylphenidate 5mg BID
.Amphetamine 5MG OD/BID
.Dextroamphetamine 2.5mg BID
• Non stimulants:
.Antidepressants
.Antipsychycotics

18. TREATMENT CONT...
• Psychological therapies.
• Behaviour modification techniques
• CBT
• Social skills training.
• Parent behaviour management training.

19. NURSING INTERVENTION
• Develop a trusting relationship with the child.
• Remove objects from immediate area in which patient could injure self.
• Provide an environment that is from from distractions.
• Ask the patient to repeat instructions before beginning a task.
• Offer recognition for successful attempts and positive reinforcement .
• Help him learn how to take his turn, wait in line and follow rules.
• Explain and demonstrate positive parenting techniques to parents or caregivers.

20. • Ask the patient to repeat instructions before beginning a task.
• Coordinate overall treatment plan with schools, collateral personnel, the child and the
family.

21. FOLLOW UP
• Every 1-3 weeks during initial titration.
• Every 3-6 months thereafter.
• Consider stopping if patient is stable and doing well.Stop for 1-4 weeks then re-evalvate.