Attention-deficit hyperactivity disorder
Attention deficit hyperactivity disorder is the most commonly diagnosed mental disorder of children and teens and which can also continue to adulthood. Children with ADHD may be hyperactive and unable to control their impulses or they may have trouble paying attention
Attention deficit hyperactivity disorder (ADHD) is a brain disorder marked by an on-going pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning of development.
Inattention means a person wanders off task, lacks persistence, has difficulty sustaining focus and is disorganized and these problems are not due to defiance or lack of comprehension.
Hyperactivity means a person seems to move about constantly, including in situations in which it is not appropriate or excessively fidgets, taps, or talks.
Impulsivity means a person makes hasty actions that occur in the moment without first thinking about them and that may have high potential for harm or a desire for immediate rewards or inability to delay gratification. An impulsive person may be socially intrusive and excessively interrupt others to make important decisions without considering the long-term consequences.
This disorder is characterized by severe disruption of attention along with over activity more frequent and severe than is typical of children at a similar level of development. ADHD is thought to result from brain damage during birth. A child with ADHD cannot sit still or remain at one place for any length of time, is always on the go, fears no dangers, climbing and playing dangerously with house hold objects. The prevalence is much common in boys than girls
Aetiology
Biological influences
- genetics; ADHD tends to run in families
- biochemical theory; a deficit of dopamine and norepinephrine neurotransmitters has been attributed to cause over activity as seen in ADHD
Pre, Peri and postnatal factors
- prenatal toxic exposure
- prematurity
- fetal distress
- precipitated or prolonged labour
- perinatal asphyxia
- low Apgar scores
- postnatal infections
- CNS abnormalities resulting from trauma
Environmental influences
- lead poisoning
- food additives, colouring, preservatives and sugars
Psychosocial factors
- prolonged emotional deprivation
- stressful psychic events
- disruption of family equilibrium
Risk factors
- drug exposure in utero
- birth complications
- low birth weight
- lead poisoning
Clinical features
- sensitive to stimuli, easily upset by light, noises or environmental changes
- more commonly active an sleeps little
- short attention life span
- failure to finish tasks
- impulsivity
- memory and thinking difficulties
- specific learning disabilities
In school
- answers only the first two questions and often blurts out answers before questions have been completed
- unable to wait to be called on in school and may respond before everyone else
- has difficulty awaiting in games or group situations
- often loses things necessary for tasks or activities at school
Home
- explosive or irritable
- emotionally labile and easily set off to laughter or tears
- unpredictable mood
- impulsiveness and inability to delay gratification
- often talks excessively
- often engages in physically dangerous activities without considering possible consequences
Symptoms can also be grouped as follows;
Inattention symptoms
- Overlook or miss details or make careless mistakes in schoolwork
- Have problems sustaining attention in tasks or play including conversations, lectures or lengthy reading
- Not seem to listen when spoken to directly
- Not follow instructions and fail to finish school work or duties on work or start tasks but quickly lose focus and get easily side-tracked
- Have problems organizing tasks and activities, such as what to do in sequence, keeping materials and belongings in order, having messy work and poor time management and failing to meet deadlines
- Avoid or dislike tasks that require sustained mental effort, such as school work or homework.
- Loose things necessary for tasks or activities such as school supplies, pencils, books, tools, eyeglasses, paperwork etc.
- Be easily distracted by unrelated thoughts or stimuli
- Be forgetful in daily activities like keeping appointments.
Hyperactivity-impulsivity symptoms
- Leave seats in situations when staying seated is expected such as in classroom
- Run or dash around or climb in situations where it is inappropriate or restless in teens
- Be unable to play or engage in hobbies quietly
- Be constantly in motion or ‘on the go’ or act if ‘driven by a motor’
- Talking nonstop
- Blurt out an answer before question has been completed, finish other peoples sentences or speak without waiting for a turn in conversation
- Have trouble waiting for his or her turn
- Interrupt or intrude on others, for example conversations, games or activities
- Constant fidgeting
- Acting without thinking
- Little or no sense of danger
MANAGEMENT
Pharmacotherapy;
Medication do not offer permanent cure for ADH but may help someone with the condition to concentrate better, be less impulsive, fell calmer and learn to practice new skills. Drugs licensed for treatment of ADHD include;
- Methylphenidate one tablet once a day
- Lisdexamfetamine once capsule once a day
- Dexamfetamine one tablet once or twice a day
- Atomoxetine one capsule once or twice a day
- Guanfacine one tablet once a day
- tricyclic antidepressants
- Antipsychotics
- serotonin specific reuptake inhibitors
Psychological therapies
- Psychotherapy especially behavioural therapy is very essential as it aims at a child changing their own behaviour. It might involve practical assistance such as help organizing tasks or completing schoolwork or working through emotionally difficult events
- Cognitive behavioural therapy; here a therapist tries to change how a child thinks about the situation and in turn would change the behaviour
- social skill training
- family therapy
Nursing interventions
Children with ADHD need guidance and understanding from their parents, families, and teachers to reach their full potential and to succeed. For school age children, frustration, blame and anger may hinder recovery in other wards children need special help to overcome negative feeling and to develop new skills and attitudes.
- Social skills training; this will help the child learn how to behave in social situations by learning how their behaviours affect others
- Parenting skills training (behavioural parent management training) this teaches parents the skills to encourage and reward positive behaviours in their children. It helps parents learn how to use a system of rewards and consequences to change a child’s behaviour
- Stress management techniques, these can benefit parents of children with ADHD by increasing their ability to deal with frustration so that they can respond calmly to their child’s behaviour
- Support groups; these help parents and families connect with others who have similar problems and concerns. Groups often meet regularly to share frustration and successes to exchange information about recommended specialists and strategies and to talk with experts
- Diet; sugar, food colourings and additives as well as caffeine should be excluded in the patients diet as they aggravate hyperactivity
Help the child with ADHD to stay organised and stay organised by;
- Keeping a routine and a schedule. Keep the same routine every day from wake-up time to bedtime. Include times of homework, outdoor play and indoor activities. Write all changes on the schedule in advance as possible
- Organizing everyday items; have a place for everything and keep everything in its place. This includes clothing, backpacks and toys
- Using homework and notebook organizers. Stress to the child the importance of writing down assignments and bringing home necessary books
- Being clear and consistent. Children with ADHD need consistent rules they can understand and follow
- Giving praise or rewards when rules are followed. Children with ADHD often receive and expect criticism. Look for good behaviour and praise it.
- Develop a trusting relationship with the child that conveys acceptance of the child separate from unacceptable behaviour
- Ensure patient has a safe environment free from dangerous objects that can injure him due to random hyperactive movements
- Keep the child in an environment that is free from distractions to help him comply on given tasks
- Ensure child’s attention by calling his name and maintain an eye contact before giving instructions
- Ask patient to repeat instructions before beginning the task
- establish goals that allow the patient to complete part of the task, rewarding each step completion with a break for physical activity
- Provide assistance on one-to-one basis beginning with simple concrete instructions
- Gradually decrease the amount of assistance given to task performance while assuring patient that assistance is available if still needed
- Offer recognition for successful attempts and positive reinforcement for attempts made
- Provide quiet environment, self-contained classrooms an small group activities
- Help the patient to learn how to take his turn, wait in line and follow rules
- Provide information an materials related to the child’s disorder and effective parenting techniques
- Explain and demonstrate positive parenting techniques to parents such as being vigilant in identifying the child’s behaviour and responding positively to that behaviour
- Co-ordinate overall treatment plan with schools, child and family