child Health Nursing

1. ATTENTION DEFICIT HYPERACTIVITY
DISORDER
Submitted to – Mrs. Anureet kaur
Submitted By- Akashdeep Kaur
B.sc(n)4th year
Roll no-1

2. INTRODUCTION….
 ADHD characterized by inattentiveness, over
activity & impulsiveness, is the best studied
yet the most controversial of the mental
disorders arising in childhood.
 It is commonly occur in boys.

3. DEFINITION….
 It is also known as HYPERKINETIC SYNDROME.
 Hyperkinetic is the Greek derivative meaning
OVERACTIVE for which the Latin derivative would be
SUPERACTIVE.
 It is the abnormal over activity, restlessness, running,
climbing or inattentiveness.

4. OR (CONTD…)
ADHD is the most common disorder of
childhood is characterized by deficit in attention,
concentration, activity level & impulse control.

5. OR(CONTD…)
 Attention Deficit Disorder is a biologically
based condition causing a persistent pattern of
difficulties resulting in one or more of the the
following behaviors:
Inattention
Hyperactivity
Impulsive

6. CONTD…
1.inattention- difficulty attending or focusing on a specific
task. People with Attention Deficit Disorder may
become distracted within a matter of minutes.

7. 2. Hyperactivity - difficulty inhibiting behavior. These
people are in constant motion. They may engage
in excessive fiddling, leg swinging, and squirming
in their chair.
3. Impulsivity - difficulty controlling impulses. These
people do not stop and think before they act. They
say and do whatever comes into their mind
without thinking about the consequences.

8. EPIDEMIOLOGY….
 It is most commonly present in school
children.
 Prevalence of ADHD is 3 to 5% in
school children.
 It is more prevalent in boys than girls
& symptoms are always present
before the age of seven.

9. ETIOLOGY…
2.Exposure
To Toxic
Substance
1.Hereditar
y Causes 7
Behavior
dis-
inhibition
3.Organic
Brain
Damage
4.Psychosocial
adversity in
infancy 5. social
6. Early
neuro
development
al problems
Etiological
Factors………

10. ETIOLOGY…
1.Hereditary Causes
 It has been seen that most of the genes that have
ADHD pattern are transmitted to the next
generation. It has been also observed that most of
the ADHD pattern behavior comes from studies of
family, adoption, and molecular genetic research.
 Adoption Studies : When there is an adoption,
then emphasis is always given to the similarity
between the biological relatives and the child. The
child should not resemble the adopted relatives
more. It has been seen that hyperactive children
resembled their biological parents more than the
adopted parents when it came to hyperactivity.

11.  Twin Studies : It has been seen that identical
twins show more tendency to acquiring genetic
behavior than non – identical twins. Thus
identical twins normally acquire the behavioral
pattern through the genes.
 Molecular Genetic Research : According
to this research, a particular type of gene is
responsible for passing the behavioral disorder.
These specific genes when transferred produce
ADHD. This specific gene has been identified
as having dopamine.

12. CONTD…
2.Exposure To Toxic Substance-
 Another one of the common causes of ADHD is
when the person gets exposed to tobacco or
alcohol during pregnancy.
 This woman later transmits the problem to the
children.
 The consumption of tobacco and alcohol leads to
the brain tissue getting damaged and cause a
problem like ADHD.

13. CONTD….
3.Organic Brain Damage - the first suggestion
about the possible cause of ADD was put forward
in 1908 by Tredgold, who stated that hyperactivity
was linked to organic brain damage which he
believed was caused by injury, oxygen deprivation,
prenatal complications or infection during birth.

14. CONTD….
4.Psychosocial adversity in infancy
5. social- WHO states that diagnosis of
ADHD can represent disruption in family
equilibrium.
 A relationship between caregiver have a
profound effect on attentional and self-
regulatory abilities.
 children who have suffered violence,
emotional abuse & neglected have typical
behavior of ADHD.

15. CONTD
6. Early neuro developmental
problems- e.g. prematurity,
fetal distress, obstetric
complications, genetic
abnormalities.
7. Behavior dis-inhibition-
results in problems with memory,
self regulation of affect, motivation,
arousal, capacity for reasoning &
reflection.

16. RISK FACTORS….
 Anxiety disorder
 Depression
 Alcohol
 Mental retardation
 Low birth weight baby
 Parental deprivation
 Abuse

17. CONTD….
 Minor physical anomalies
 Brain insult
 Family history of ADHD
 Neglected child

18. PATHOGENESIS….
Deviation in the density of dopamine receptor
Dysfunction in the frontal cortex & basal ganglia
Causes

19. CONTD…….
ADHD
Hemisphere dysfunction
Increased activity of basal ganglia & decreased activity of
frontal motor

20. CLINICAL MANIFESTATIONS...
 Inattention,
 hyperactivity,
 and impulsivity- are the
key
behaviors of ADHD.
 To be diagnosed with the
disorder, a child must have
symptoms for 6 or more
months and to a degree that is
greater than other children of
the same age.

21. CONTD….
1. INATTENTIVENESS- it
involves
 Short attention span
 Distractibility
 Failure to finish task
 Difficulty in organizing tasks &
play activities
 Forgetfulness
 Carelessness
 Makes careless mistakes in
school work
 Difficulty in watching a movie or
T.v.

22. CONTD….
 Not listen when spoken to
directly
 Does not follow instructions
2. Hyperactivity- it includes
following-
 Feeling of restlessness
 Excessive talking
 Excessive running & climbing in
any situation which is
inappropriate
 Difficulty playing quietly
 Seeming to be driven by a
tireless motor

23. CONTD….
 Difficulty remaining seated when peers routinely stay seated
 Fidgeting behavior
 Constant Squirming in their seats

24. CONTD….
3. Impulsivity- it includes –
 Blurting out answers prematurely
 Difficulty awaiting a turn
 Interruption
 Impairment in cognitive tasks can
be observed before 7yrs
 Impairment in social, academic or
occupational functioning
 Accidental injuries as a result of
impulsive tendency.

25. DIAGNOSIS….
Collect history from parents, teacher & other children
Physical examination
Identify the causative factors
Continuous performance test

26. CLINICAL COURSE….
 ADHD is a chronic disorder leads to a negative impact on
child’s functioning throughout the life cycle
 ADHD children exhibits impaired academic functioning,
poorly performs cognitive tasks, low self esteem & poor
social functioning.
 High school drop out or less education level

27. CONTD….
 Lower occupational ranking at 25yrs of age.
 Increased risk for developing antisocial personality disorders
& substance abuse disorders in adulthood.

28. COMPLICATIONS….
 Emotional disorders
 Anxiety (type of neurosis)
 Oppositional defiant disorder (a form
of aggressive behavior)
 Conduct disorder
 Have difficulty in completing project
on time

29. CONTD….
 Have trouble paying attention in work
 Spend hours at work, but get very little done
 Forgetfulness

30. APPORCH TOWARDS THE PATIENT….
 FIRM
 FRIENDLY
 CALM

31. TREATMENT….
 Psychosocial interventions
 Behavior management training
 Pharmacotherapy
 Nursing management

32. PSYCHOSOCIAL INTERVENTIONS
 Improve child relationship with parents, sibling, teachers
and peers.
 Decrease disruptive behavior
 Increase independence in completing homework
 Improve self esteem.

33. BEHAVIORAL MANAGEMENT TRAINING
1. Family &individual psychotherapy- may be
necessary in complex situations or to address overt
mental health conditions such as depression, anxiety,
social withdrawal, school phobia etc.
2. Parent & teacher training- parents & teachers must
implement specific techniques of positive rewards to
the child for demonstrating desired behavior or
consequences for failure to meet the goals (negative
reward)

34. CONTD…
3.Parent training- parents learn principles of
behavior management with consistency, while
children work on improving peer relationships
and self-esteem.
 Specific target behaviors are identified that
impair the child's daily life functions (e.g.
violating home, school rules, disruptive
behavior etc)
4. Social skills training- training may consist
of 8-12 weekly individual or group sessions.
5. Cognitive behavior therapy
6.Classroom interventions

35. CONTD…
7. School interventions-ensure app.
Learning needs; teacher guidance; provision
of conducive environment to optimize child’s
learning.
8. Behavioral management plan- positive
reinforcement on desired work habits, social
skills groups.

36. CONTD…
9. Special educational service and support should be
provided in the least restrictive environment, so often ADHD
children continue in the regular classroom with appropriate
modifications and accommodations rather than being placed
in a separate special classroom.
10. Daily report card

37. ACTIVITIES FOR ADHD CHILDREN:
1. Scouting -
 Scouting is perhaps one of the best activities available for
boys and girls with ADHD.
 Scouting includes many of the elements that can help your
child to focus, providing physical stimulation, highly
structured activities that make use of various learning styles,
consistent peer interaction, close adult supervision,
competition, and, most of all, fun.
2. Team sports --Baseball, basketball, football and soccer
can all be a good choice for your child, as they require
team involvement and high physical energy.

38. CONTD…
3. Martial Arts – this
require a lot of mental and
physical activity and can
keep an ADHD child
focused for hours.
4. others- like
woodworking or model
building, dance classes
,music classes etc.

39. PHARMACOTHERAPY….
Antidepressants-
 Imipramine – 20-
100mg/kg
 Desipramine – 20-
100mg/kg
 Clomipramine – 25-
100mg/kg

40. CONTD….
Stimulants –are the most
effective psychotropic
agents in treating ADHD.
Two main classes are :
 Amphetamine – 10-
40mg/kg(dexadrine)
 Methylphenidate – 10-
60mg/kg( ritalin)

41. CONTD….
Antipsychotics –
(typical)
 Haloperidol (0.5-2.0mg)
 Thioridazine(0.5 to 3.0 mg per kg)
 (atypical)
 Resperidone- (2-8mg p/o)
 Olanzapine- (5-20mg) p/o
 Anticonvulsants –
 Phenytoin
 Valporate

42. SIDE EFFECTS OF DRUGS….
Stimulants –
 Appetite loss
 Sleep disturbances
 Cramps
 Depression
 Irritability
 Hallucinations

43. CONTD….
 Tics
 Growth slowing

44. Antidepressants –
 Sedation
 B.P. changes
 Dizziness
 Headache
 Constipation & urinary retention

45. PROGNOSIS….
 Timely intensive treatment can
improve prognosis
 In at least 80% of affected
children, symptoms of ADHD
persist into adolescence and
adulthood.
 With increasing age: hyperactivity
tends to decrease.
 With combination of medication
and psychosocial and behavioral
interventions, most children’s
symptoms are significantly
improved.

46. NURSING MANAGEMENT….
 Assess for –
 Hyperactivity
 Restlessness
 Carelessness
 Forgetfulness etc.

47. NURSING DIAGNOSIS….
1.Disturbance in balance of rest, sleep & activity related to
purposeless movements as evidenced by active behavior.

48. INTERVENTIONS RATIONALE
 Provide time for a rest
period, nap or quiet time
during daily schedule.
 Observe the pt. closely for
signs of fatigue & monitor
sleep patterns
 The pt. increased activity
level increases need for
rest.
 The pt. may be unaware of
fatigue or may ignore the
need for sleep or rest.

49. CONTD…
INTERVENTIONS RATIONALE
 Decrease stimuli before the
pt. sleep.
 Provide clean &comfortable
bed.
 Provide soothing music to
the client
 Limiting noise & other
stimuli will help encourage
rest & sleep.
 Encourage rest & sleep
 -do-

50. NURSINGDIAGNOSIS…
2. Disturbance in interpersonal communication related to poor
impulse control as evidenced by short attention span.

51. INTERVENTIONS RATIONALE
 Use a firm, yet calm &
relaxed approach.
 Make only those promise
you can realistically keep.
 Your presence & manner
will help to communicate
the pt.
 Breaking a promise will
results in the pt. mistrust &
poor relationship develop.

52. CONTD…
INTERVENTIONS RATIONALE
 Initially assign pt. to one
staff member
 Show acceptance of the pt.
as a person.
 Pt. ability to communicate
is improved.
 Pt. is accept as a person
regardless behavior.

53. NURSINGDIAGNOSIS
3. Bizarre or inappropriate behavior, dress or appearance
related to low self esteem as evidenced by active behavior.

54. INTERVENTIONS RATIONALE
 Reorient the pt. to person,
time & place.
 Spend time with pt.
 Repeated presentation of
reality is concrete reinforce
 Improve behavior.

55. CONTD…
INTERVENTIONS RATIONALE
 Ignore or withdraw your
attention from bizarre dress
or behavior.
 Stand on the side of the
client.
 Better than negative
reinforcement.
 Prevent injury.

56. NURSINGDIAGNOSIS…
4. Disturbed eating pattern r/t hyperactivity & inattention as
evidenced by weight loss.

57. INTERVENTION RATIONALE
 Monitor the pt. eating
pattern & food &fluid intake.
 Record intake & output.
 Give high protein, high
caloric diet with
supplemental feedings.
 Pt. ignore feelings of thirst
& hunger.
 Tells about nutritional
status.
 It gives energy to pt.

58. CONTD….
INTERVENTION RATIONALE
 Give finger food like rolled
chapatti, apple, banana,
sand-which.
 Fortification of food e.g.
flour mixed with soya bean,
grams.
 Allow food while running.
 Provide energy to client.

59. NURSING DIAGNOSIS...
5.Potential for injury r/t hyperactivity & impulsive behavior as
evidenced by lack of control over purposeless & potentially
injurious activity.

60. INTERVENTION RATIONALE
 Avoid highly competitive
activities.
 Encourage pt. to do small
activities.
 Don’t leave pt. alone.
 It can exacerbate pt.
condition.
 Prevent injury.
 Reduces chances of injury.

61. CONTD…
INTERVENTION RATIONALE
 Keep limit furniture in room.
 Remove hazardous objects
as sharp instruments, rope,
necktie.
 Use paper items instead of
glass.
 Prevent injury.
 Prevent injury.
 -do-

62. CLIENT EDUCATION….
1. Teach family members behave calmly as much as with the
client
2. Teach parents to give simple instructions with only one
thing to do at a time
3. The child should be rewarded
4. Study periods should be brief with constant feedback

63. CONTD…..
5. Child with ADHD placed in front of class in the school
6. Teach teachers to co-perate with child.

64. SUMMIRIZATION
 Definition
 Epidemiology
 Etiology
 Risk factors
 Pathogenesis
 Clinical manifestations
 Diagnosis
 Complications
 Prognosis
 Treatment
 Nursing diagnosis

65. RECAPTULIZATION
Q.1. Define ADHD?
Q2. What are the etiological factors of
ADHD?
Q3. What are the clinical manifestations of
ADHD?
Q4. What are the activities for children with
ADHD?

66. ANY QUERIES??????

67. ASSIGNMENT
Write in detail about the management of the
with child with ADHD.

68. BIBLIOGRAPHY
1. http://books.google.co.in/books?hl=en&q=kp+neeraja+psy
chiatric+nursing
2. http://www.google.co.in/search?source=ig&hl=en&rlz=1G1
GGLQ_ENIN367&q=psychosomatic+disorders&meta=lr%3
D&aq=0&oq=psychosomatic+disorder
3. http://www.google.co.in/search?source=ig&hl=en&rlz=1G1
GGLQ_ENIN367&q=psychophysiological+disorders+definit
ion&meta=lr%3D&aq=0&oq=psychophysiological+disorder
s
4. NEERJA K.P ‘ESSENTIAL OF MENTAL HEALTH &
PSYCHIATRIC NURSING’ JAYPEE BROTHERS
MEDICAL PUBLISHERS PVT. LTD 2007.