Adhd ppt

ADHD

1. ATTENTION DEFICIT/HYPERACTIVITY DISORDER MR.ASHOK KUMAR M. s c Nursing 2 nd year

2. INTRODUCTION Attention-deficit hyperactivity disorder 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 Children with ADHD may be hyperactive and unable to control their impulse or they may have trouble paying attention

3. 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). ADHD is a brain disorder marked by an ongoing pattern of inattention and hyperactivity impulsivity that interferes with functioning or development

4. 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.

5. PREDISPOSIG FACTORS Biological Influences GENETICS: Twin studies indicate that the disorder is highly heritable and that genetics are a factor in about 75% of ADHD. Siblings of hyperactive children have higher incidences of ADHD. BIOCHEMICAL FACTORS: An elevation in the catecholamines dopamine and norepinephrine have been implicated in the overactivity causes to ADHD. Norepinephrine modulates attention, arousal, and mood.

6. continue Dopamine is involved in reward, risk taking, impulsivity and mood. One study found that in adults with ADHD, the dopamine transporter in the brain was elevated by 70percent compared to people without ADHD (Med- scape Health, 2002). PRENATAL FACTORS: Alcohol and tobacco smoke exposure during pregnancy. Hypoxia (Lack of oxygen) to the fetus. Premature birth.

7. ENVIRONMENTAL INFLUENCES Environmental Lead: The adverse effects on cognitive and behavioural development in children with elevated body levels of lead. DIET FACTORS Artificial food colours . Preservative sodium benzoate. Another diet factor that has been receiving much attention in its possible link to ADHD is sugar. One study reported that ADHD children had fewer problems after a high-carbohydrate breakfast than after a high-protein one (Med scape Health,2002). PSYCHOSOCIAL INFLUENCES: Family dysfunction. Inadequacies in the educational system. A high degree of psychosocial stress, maternal mental disorder, paternal criminality, low socioeconomic status, and foster care have been implicated ( Dopheide & Theesen , 1999).

8. DSM-IV-TR Diagnostic Criteria for Attention-Deficit/Hyperactivity Disorder Six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level: Inattentiveness: It involves , Short attention span or a tendency to make careless errors in schoolwork or other activities. Difficulty with sustained attention in tasks or play activities. Apparent listening problems. Difficulty following instructions. Problems with organization.

9. continue Avoidence or dislike of tasks that require mental effort. Tendency to lose things like toys, notebooks, or homework. Distractibility. Forgetfulness in daily activities. Six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level: Hyperactivity

10. Difficulty remaining seated. Fidgets with hands or feet or Squirms in seat. Excessive running and climbing. Difficulty playing quietly. Difficulty waiting for a turn or in line. Impulsivity : It includes . Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7years. Some impairment from the symptoms is present in two or more settings ( e.g ; at school or work and at home). There is clear evidence of clinically significant impairment in social, academic, or occupational functioning.

11. Anxiety can accompany ADHD as a secondary feature, and anxiety alone can be manifested by over activity and easy distractibility. A child with ADHD to become demoralized and to develop depressive symptoms in reaction to persistent frustration with academic difficulties and resulting low self-esteem. Mania and ADHD share many core features such as excessive verbalization, motor hyperactivity, and high levels of distractibility. Mania and ADHD can coexist, children with bipolar-1 disorder exhibit more waxing and waning of symptoms than those with ADHD.

12. MANAGEMENT Pharmacotherapy: Pharmacologic treatment is considered to be the first line of treatment for ADHD. Central nervous system stimulants are the first choice of agent in that they have been shown to have the greatest efficacy with generally mild tolerable side effects. Methylphenidate (Ritalin) initial dosage: 5mg before breakfast and lunch. Dosage may be increased gradually in increments of 5 to 10mg/day at weekly intervals, PO(Children age 6 and older)

13. Continue Pemoline ( Cylert ) initial dosage:37.5mg/day, administered as a single dose each morning Dosage may be gradually increased at 1-week intervals in increments of 18.75mg/day until the desired effect is achieved. Effective dosage usually ranges from 56.25 to 75mg/day PO. Clinical benefit may not be observed for 3 to 4 weeks. Bupropion ( wellbutrin ): 3mg/kg/day PO. Imipramine ( Tofranil ) 1mg/kg/day in divided doses, with increases every 2 to 3 weeks up to a maximum of 2.5mg/kg/day.

14. Continue… BEHAVIOURAL THERAPY: Behavioral therapy attempts to change behavior pattern by, Recognizing a child’s home and school environment. Giving clear directions and commands. Setting up a system of consistent rewards for appropriate behaviors and negative consequences for inappropriate ones. Behavioral strategies that may help a child with ADHD:

15. Create a routine. Get organized. Avoid distractions. Limit choices. Change your interactions with your child. Use goals and rewards. Discipline effectively. Help your child discover a talent. ALTERNATIVE TREATMENTS Occupational therapy Body treatments Diet manipulation Allergy treatment Attention training Visual training Traditional one-on-one “talking” psychotherapy. PARENT TRAINING: Parent education and support groups to help family members accept the diagnosis and to teach them how to help kids organize their environment,

16. NURSING MANAGEMENT Risk for injury R/T impulsive & accident-prone behavior & inability to perceive self harm  Impaired social interaction R/T intrusive behavior.

17. Nursing intervention 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 client’s participation if adequate supervision is not possible. -Identify deliberate behavior that put the child at risk.

18. Reference Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 10th Edition. Semple David Oxford handbook of psychiatry 1 st edition 2005 Townsend M.C Essentials of psychiatric mental health nursing 4 th edition Lipincott manual of nursing practice 8 th edition.