Management of patient with ADHD

1. ATTENTION DEFICIT
HYPERACTIVITY DISORDER (ADHD)
OR
HYPERKINETIC DISORDER
PREPARED BY
MRS. DIVYA PANCHOLI
ASSISTANT PROFESSOR, SSRCN, VAPI
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2. DEFINITION
•Hyperkinetic disorder (Attention-Deficit
Hyperactivity Disorder or ADHD) is a persistent
pattern of inattention and or hyperactivity
more frequent and severe than is typical of
children at a similar level of development.
•The syndrome was first described by Heinrich
Hoff in 1854
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3. Epidemiology
•A prevalence of 1.7 percent was found
among primary school children
•ADHD is four times more common in
boys than in girls.
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4. Etiology
•Biological influences
•Geneticfactors
There is greater concordance in monozygotic than in dizygotic
twins
 Siblings of hyperactive children have about twice the risk of
having the disorder as does the general population
Biological parents of children with the disorder have a higher
incidence of ADHD than do adoptive parents
•Biochemical theory: A deficit of dopamine and
norepinephrine has been attributed in the overactivity seen
in ADHD.
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5. CONTI…..
Pre, peri and postnatal factors
Prenatal toxic exposure, prenatal mechanical insult to the fetal nervous
system
 Prematurity, fetal distress, precipitated or prolonged labor, perinatal
asphyxia and low Apgar scores
Postnatal infections,CNSabnormalities resulting from trauma, etc
Environmental influences
Environmental lead
Food additives, coloring preservatives and sugar have also been suggested
as possible causes ofhyperactive behavior but there is no definite evidence
Psychosocial factors
Prolonged emotional deprivation
Stressful psychic events
Disruption of family equilibrium
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6. Clinical Features
• Sensitive to stimuli, easilyupset
by noise,light, temperature and
other environmental changes.
• At times the reverse occurs and
the children are flaccid and limp,
sleep more and the growth and
development is slow in the first
month of life.
• More commonly active in
crib,sleep little.
• General coordination deficit.
• Short attention span, easily
distractable.
• Failure to finish tasks.
• Impulsivity.
• Memory and thinking deficits .
• Specific learning disabilities
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7. In school
•Often fidgets with hands or feet or squirms in seat.
•Answers only the first two questions ; often blurts out
answers to questions before they ' have been completed.
•Unable to wait to be called on in school and may respond
before everyone else.
•Has difficultyawaiting turn in games or group situations.
•Often loses things necessary for tasks or activities at
school.
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8. Home
•Explosive or irritable.
•Emotionally labile and easily set off to laughter or
tears.
•Mood is unpredictable.
•Impulsiveness and an inability to delay gratification.
•Often talks excessively.
•Often engages in physically dangerous activities
without considering possible consequences
(forexample, runs into street without looking).Mrs. Divya Pancholi 8

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11. Diagnosis
•Detailed prenatal history and early
developmental history.
•Direct observation, teacher's school report
(often the most reliable), parent's report
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13. Treatment
Pharmacotherapy
CNS stimulants:
Dextroamphetamine,
methylphenidate,
pemoline
Tricyclic antidepressants
Antipsychotics
Serotonin specific re-
uptake inhibitors
Clonidine
Psychological therapies
Behavior modification
techniques
Cognitive behavior
therapy
Social skills training
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16. NURSING DIAGNOSIS:
•Risk for injury related to impulsive and accident-
prone behavior and the inability to perceive self-
harm.
•Impaired social interaction related to intrusive
and immature behavior.
•Low self-esteem related to dysfunctional family
system and negative feedback.
•Noncompliance with task expectations related to
low frustration tolerance and short attention span.
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17. Nursing Intervention
• Develop a trusting relationship with the child. Convey acceptance
ofthe child separate from the unacceptable behavior.
• Ensure that patient has a safe environment. Remove objects from
immediate area in which patient could injure self due to random
hyperactive movements. Identify deliberate behaviors that put the
child at risk for injury. Institute consequences for repetition of this
behavior. Provide supervision for potentially dangerous situations.
• Since there is non-compliance with task expectations, provide an
environment that is as free of distractions as possible.
• Ensure the child's attention by calling his name and establishing eye
contact, before giving instructions.
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18. CONTI…
• Ask the patient to repeat instructions before beginning a task.
• Establish goals that allow patient to complete a part of the task,
rewarding each step completion with a break for physical activity.
• Provide assistance on a one-to-one basis, beginning with simple
concrete instructions.
• Gradually decrease the amount of assistance given to task
performance, while assuring the patient that assistance is still
available if deemed necessary.
• Offer recognition of successful attempts and positive reinforcement
for attempts made. Give immediate positive feedback for acceptable
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19. CONTI…
• Provide quiet environment, self-contained classrooms, and small
group activities.Avoid over stimulating places such as cinema halls,
bus stops and other crowded places.
• Assess parenting skill level, considering intellectual, emotional and
physical strengths and limitations. Be sensitive to their needs as
there is often exhaustion ofparental resources due to prolonged
coping with a disruptive child.
• Provide information and materials related to the child's disorder and
effective parenting techniques. Give instructional materials in
written and verbal form with step-by-step explanations.
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20. CONTI…
• Explain and demonstrate positive parenting techniques to
parents or caregivers, such as time-in for good behavior, or
being vigilant in identifying the child's behavior and
responding positively to that behavior.
• Educate child and family on the use of psychostimulants and
anticipated behavioral response.
• Coordinate overall treatment plan with schools, collateral
personnel, the child and the family.
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22. Care of children at home:
•Show your child lots of affection.
•Be patient
•Keep things in perspective
•Take time to enjoy your child.
•Try to keep a regular schedule
for meals, naps and bedtime
•Make sure your child is rested
•Identify difficult situations
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23. Cont… •Use timeouts or the loss of a
privilege to discipline your child
•Work on organization.
•Find ways to enhance your child's
self-esteem and sense of
discipline
•Use simple words and
demonstrate when giving your
child directions
•Take a break yourself.
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24. You can refer following link also
• https://www.youtube.com/watch?v=vQRh_VMA7Vc
• https://www.youtube.com/watch?v=RMaCE5RT54c
• https://www.youtube.com/watch?v=kWOavIudlXc
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