This document discusses attention deficit hyperactivity disorder (ADHD). It defines ADHD as a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. The document covers the causes, symptoms, diagnostic criteria, treatment options, and nursing role for patients with ADHD. Treatment involves behavioral therapy, environmental modifications, classroom accommodations, and may include stimulant medications to manage symptoms. A multimodal treatment approach involving patients, families, and medical professionals can help improve outcomes for those with ADHD.

1. PRESENTED BY:
K. SIVASAKTHI,
M.SC NURSING IST YEAR,
CON- PIMS.

3. INTRODUCTION:
It is a neurobehavioral developmental
disorder and is primarily characterized
by” the co-existence of attention
problems, hyperactivity with each
behavior occurring infrequently alone.”
While symptoms may appear to be
innocent and merely annoying
nuisances to observers.

4. DEFINITION
ADHD refers to a chronic bio
behavioral disorder that
initially manifests in childhood
and is characterized by
hyperactivity, impulsivity,
and/ or inattention. These
symptoms can lead
to difficulty in
academic, emotional, and
social functioning.

5. DEFINITION
ADHD is a persistent pattern of in
attention and or hyperactivity-impulsivity
that is more frequent and severe than is
typically observed in individuals at a
compatible level of development (APA,
2000).

6. EPIDEMIOLOGY:
It is four to nine times more common
in boys than in girls.
Prevalence of ADHD is 3 to 7 percent
of school-age children.
It is most commonly present in school
children

7. CAUSES
The cause of ADHD has not
been fully defined.
A genetic predisposition has
been demonstrated in (identical)
twin and sibling studies.
Biochemical theory: An elevation in the
catecholamine dopamine and epinephrine
have been implicated in the over activity
attributed to ADHD.

8. Prenatal factors:
Maternal smoking
Hyperkinetic
impulsive behavior in
offspring
Intrauterine exposure
to toxic substances-
alcohol
fetal alcohol syndrome

9. Postnatal factors:
cerebral palsy
epilepsy
CNS abnormalities

10. Perinatal
prematurity
signs of foetal distress
precipitated prolonged labour
perinatal asphyxia
low Apgar scores
Environmentalfactors
Diet factor

11. Psychosocial influences:
stress
maternal mental disorder
parental criminality
low socio-economic status
family history of alcoholism
parental history of hyperactivity
developmental learning disorder

12. CLASSIFICATION
Predominantly hyperactive-
impulsive:
• Children with this type of
ADHD show primarily
hyperactive and impulsive
behavior.
• This can include fidgeting,
interrupting people while they
are talking and being able to
wait for their turn.

13. Predominantly inattentive
• Children with this type of
ADHD have extreme difficulty
in focusing finishing tasks and
following instructions.
• This type of is most common
among girls with ADHD.

14. Combined hyperactive-
impulsive and inattentive
• Children with this combined
type of ADHD display both
inattentive and hyperactive
symptoms.
• These includes an inability
to pay attention, a tendency
toward impulsiveness and
above normal levels of
activity and energy.

15. CLINICAL FEATURES
Inattention:
Fails to give close attention to
details or makes careless
mistakes in schoolwork, work, or
other activities.
Difficulty sustaining attention in
tasks or play activities.
The child often does not seem to
listen when spoken to directly.

16. Does not follow instructions and fails to
finish schoolwork, chores, or duties in the
workplace
Difficulty in organizing tasks and
activities.
Avoids, dislikes, or is reluctant to engage
in tasks that require sustained mental
effort
Easily distracted by extraneous stimuli.
Forgetful in daily activities

17. Hyperactivity:
The child often fidgets with his/her hands
or feet or squirms in his/her seat.
The child often runs about or climbs
excessively in situations in which it is
inappropriate.
The child often has difficulty playing or
engaging in leisure activities quiet
The child often talks excessively.

18. Impulsivity:
The child often blurts out answers before
questions have been completed.
The child often has difficulty awaiting
his/her turn
The child often interrupts or intrudes
in conversations

19. ASSOCIATED CONDITIONS
Conduct disorder,
Borderline personality disorder,
Primary disorder of vigilance, which is
characterized by poor attention and
concentration, as well as difficulties
staying awake.
Mood disorders.
Bipolar disorder.
Anxiety disorder,
Obsessive-compulsive disorder

20. DIAGNOSTIC CRITERIA
DSM-IV criteria for diagnosis
of ADHD requires that some
hyperactive, impulsive, or inattention
symptoms that cause present difficulties
were present before 7 years of age and
are present in two or more settings (at
school [or work] or at home).
There must be clear evidence of
significant impairment in social,
academic, or occupational functioning.

21. Inattention symptoms are most likely to
manifest about at 8 to 9 years of age and
commonly are lifelong.
The "delay" in onset of inattentive
symptoms may reflect its more subtle
nature (vs. hyperactivity) and/or
variability in the maturation of cognitive
development.

22. MANAGEMENT
Family education and
counseling
Medications
Proper classroom placement,
Environmental manipulation,
Behavioral therapy or
psychotherapy for the child

23. Medication:
Several different types of medications
may be used to treat ADHD.
Stimulants are the best known
treatment. They have been used for
the treatment of ADHD. Eg., Strattera
Non-stimulants were approved for
treating ADHD. Eg., ritaline, methylin,
focalin.
Antidepressants are sometimes a
treatment option.

24. Behavioral therapy
Receive instruction in effective
parenting skills such as
-delivering positive reinforcement
-rewarding small increments of desired
behaviors,
-providing age-appropriate consequence
- use of organizational charts for
completing self care activities
-increasing manually writing out
assignments are emphasized

25. Environmental manipulation
Teaching parents how to
make organization chart (e.g.
listing all activities that
must be performed before
leaving for school)
Decreases distractions in the environment
while the child is completing home work
(e.g. turning the TV leaving off, having a
consistent study are equipped with
needed supplies ) and helping parents to
understand ways to model positive
behaviors and problem solving

26. Appropriate classroom placement;
home work and classroom assignments
may need to be reduced,
- more time may need to be allotted for tests
to allow the child to complete the task
-verbal instruction should be accompanied by
visual reference such as written
instructions on the block board

27. academic subjects are taught in the
morning when the child is experiencing
in the effects of the morning dose of
medication.
-provide regular and frequent breaks
- Computers are helpful for children who
have difficulty with writing and fine
motor skills.
-special training for learning
difficulty

28. NURSES ROLE:
Ensure that client has safe
environment.
Remove objects from immediate
area on which client could injure
self as a result of random,
hyperactive movement.
Provide adequate supervision and
assistance.
Limit child’s participation if
adequate supervision is not
possible.
Identify deliberate behavior that put
the child at risk.

29. NURSING DIAGNOSIS
Impaired social interaction related to
inability to trust, neurological alterations
Impaired verbal communication related to
withdrawal into the self, inadequate
sensory stimulation, neurological
alterations.
Disturbed personal identity related to
inadequate sensory stimulation,
neurological alterations

30. Low self esteem related to dysfunctional
family system and negative feed back
Risk for injury related to impulsive and
accident prone behavior and inability to
perceive self harm.

31. SUMMARY

32. CONCLUSION
Proper diagnosis by a trained professional
is imperative, especially to rule out other
conditions or problems. Treatment is most
effective when it’s multimodal and involves
the family. Effective treatment does not
always have to include medication.
Although there is no cure for ADHD, a
multimodal approach can greatly improve
the symptoms and outcomes for a child
with ADHD and lead to an increase in self-
esteem and self- efficacy

33. Thank you