adhd.pptx psychiatry disorder are not diagnosed easily

Psychiatric disorders are not diagnosed as easily in children as they are in adults. Children usually lack the abstract cognitive abilities and verbal skills to describe what is happening. Because they are constantly changing and developing, children have limited sense of a stable, normal self to allow them to discriminate unusual or unwanted symptoms from normal feelings and sensations.

Attention-deficit/hyperactivity disorder (ADHD) is characterized by inattentiveness, over activity, and impulsiveness. ADHD is a common disorder, especially in boys, and probably accounts for more child mental health referrals than any other single disorder. The essential feature of ADHD is a persistent pattern of inattention and/or hyperactivity and impulsivity more common than generally observed in children of the same age.

ADHD affects 5% to 8% of school-aged children, with 60% to 85% having symptoms persisting into adolescence.
Up to 60% continue to be symptomatic into adulthood.
ADHD is four times more common in boys than in girls.
Most cases remit in adolescence: 20% of patients have symptoms into adulthood.
Biological influences

Genetic factors
• 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. This deficit of neurotransmitters is believed to lower the threshold for stimuli input

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, CNS abnormalities resulting
from trauma, etc

1. MENTAL HEALTH NURSING

2. ATTENTION-DEFICIT HYPERACTIVITY DISORDER -PRESENTER MR. SUYOG GORDE 1 ST YEAR M.SC. NURSING

3. Psychiatric disorders are not diagnosed as easily in children as they are in adults. Children usually lack the abstract cognitive abilities and verbal skills to describe what is happening. Because they are constantly changing and developing, children have limited sense of a stable, normal self to allow them to discriminate unusual or unwanted symptoms from normal feelings and sensations. INTRODUCTION

4. Attention-deficit/hyperactivity disorder (ADHD) is characterized by inattentiveness, over activity, and impulsiveness. ADHD is a common disorder, especially in boys, and probably accounts for more child mental health referrals than any other single disorder. The essential feature of ADHD is a persistent pattern of inattention and/or hyperactivity and impulsivity more common than generally observed in children of the same age. DEFINITION

5. ADHD affects 5% to 8% of school-aged children, with 60% to 85% having symptoms persisting into adolescence. Up to 60% continue to be symptomatic into adulthood. ADHD is four times more common in boys than in girls. Most cases remit in adolescence: 20% of patients have symptoms into adulthood. EPIDEMIOLOGY

6. Biological influences Genetic factors • 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   ETIOLOGY

7. Biochemical theory A deficit of dopamine and norepinephrine has been attributed in the overactivity seen in ADHD. This deficit of neurotransmitters is believed to lower the threshold for stimuli input   Pre, P eri 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, CNS abnormalities resulting from trauma, etc

8. Environmental influences • Environmental lead • Food additives, coloring preservatives and sugar have also been suggested as possible causes of hyperactive behavior but there is no definite evidence. Psychosocial factors • Prolonged emotional deprivation • Stressful psychic events • Disruption of family equilibrium

9. • Sensitive to stimuli, easily upset 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 Clinical Features

10. 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 difficulty awaiting turn in games or group situations. • Often loses things necessary for tasks or activities at school.

11. 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 (for example, runs into street without looking).

12. Complete medical evaluation, with emphasis on neurologic examination, hearing and vision. A psychiatric evaluation to assess the intellectual ability, academic achievement and potential learning disorder problem. Detailed prenatal history and early developmental history. Direct observation, teacher's school report (often the most reliable), parent's report DIAGNOSTIC EVALUATION

13. Pharmacotherapy • CNS stimulants: Dextroamphetamine , methylphenidate, pemoline • Tricyclic antidepressants • Antipsychotics • Serotonin specific re-uptake inhibitors • Clonidine Treatment

14. Behavior modification techniques Psychological therapies

15. Cognitive behavior therapy

16. Social skills training

17. • Develop a trusting relationship with the child. Convey acceptance of the 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. NURSING INTERVENTION

18. • Ensure the child's attention by calling his name and establishing eye contact, before giving instructions. • 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.

19. Offer recognition of successful attempts and positive reinforcement for attempts made. Give immediate positive feedback for acceptable behavior. • 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. Besensitive to their needs as there is often exhaustion ofparental resources due to prolonged coping with a disruptive child.

20. • 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. • 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.

21. Ineffective Role Performance: Patterns of behavior that do not match the environmental context, norms, and expectations.   Risk for trauma related to impairments in cognitive and psychomotor functioning. Disturbed thought processes related to cerebral degeneration evidence by disorientation, confusion, memory deficits, and inaccurate interpretation of environment. NURSING DIAGNOSIS

22. Low self esteem related to loss of independent functioning evidenced by expression of shame and self degradation and progressive social isolation. Self care deficit related to disorientation, confusion, memory deficits evidenced by inability to fulfill activities of daily living. Defensive coping related to dysfunctional family system.

23. There is a high co-morbidity between ADHD and other disorders including substance use/abuse, antisocial behavior, anxiety disorders, and mood disorders. To promote health through adulthood, individuals with ADHD could benefit from strategies to prevent other psychiatric disorders as well as early identification and treatment of coexisting disorders. CONCLUSION

24. Write 3 nursing care plans on ADHD. ASSIGNMENT