ADHD.pptx

Attention deficit hyperactivity disorder

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

2. 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.

3. 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.

4. 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).

5. 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

6. 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.

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

8. Postnatal factors: cerebral palsy epilepsy CNS abnormalities

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

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

11. 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.

12. 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.

13. 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.

14. 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.

15. 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

16. 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.

17. 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

18. ASSOCIATED CONDITIONS   C onduct 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

19. 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.

20. 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.

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

22. 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.

23. 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

24. 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

25. 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

26. 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

27. 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.

28. 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

29. 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.

30. SUMMARY

31. 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

32. Thank you