Attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder

1. ATTENTION DEFICIT HYPERACTIVITY DISORDER By Sreetha Akhil MSc Nsg

2. Attention Deficit Hyperactivity Disorder Attention Deficit Hyperactivity Disorder commonly known as ADHD Most common childhood disorder Continue to adolescents to adulthood More common in boys.

3. DEFINITION ADHD is consists of persistent pattern of in attention and hyperactive and impulsive behaviour.

4.  It also called hyperkinetic disorder. A neurological disorder. Unless identified & treated properly, ADHD may progress to conduct disorder, academic & job failure , depression, relationship problems, &substance abuse .

5. Most children with ADHD experience signs &symptoms by age 4. A few aren’t diagnosed until they enter school.

6. EPIDERMOLOGY 5% OF CHILDREN HAVE THIS DISODER In India 11.32% of primary school children More prevalent in boys

7. ICD-10 Classification F90.0 , Attention-deficit hyperactivity disorder, predominantly inattentive type F90.1, Attention-deficit hyperactivity disorder, predominantly hyperactive type F90.2, Attention-deficit hyperactivity disorder, combined type F90.8, Attention-deficit hyperactivity disorder, other type F90.9, Attention-deficit hyperactivity disorder, unspecified type

8. ETIOLOGY Genetic factor Higher in monozygotic twins than in dizygotic twins Siblings of hyperactive children have about twice the risk of having the disorder as does the general population. Family history of psychiatric illness 2) Biochemical factor A deficit of dopamine & norepinephrine has been attributed in the over activity seen in ADHD.  3) Developmental factor Developmental delay in milestone

9. 4 ) Pre , Intra & postnatal factors Prenatal toxic exposure , Infections. Perinatal Prematurity , foetal distress, precipitated or prolonged labour, Perinatal asphyxia & low Apgar scores. Postnatal infections, CNS abnormalities resulting from trauma, Instrumental delivery.

10. 5 ) Environmental influences Environmental lead Food additives, colouring preservatives & sugar level also been suggested as possible causes of hyperactive behaviour but there is no definite evidence 6 ) Psychosocial Factors Prolonged emotional deprivation Stress psychic events. Disruption of family equilibrium .

11. CLINICAL MANIFESTATION Lack of attention( Inattentive presentation) Fails to give close attention Difficulty in sustaining attention during tasks or play Does not appear to listen Struggles to follow through with Instruction Has difficulty with Organization of task, activities Easily distracted F ails to finish schoolwork , routine task , or duties

12. 2) Hyperactivity and Impulsivity Fidgets with hands or feet or squirms in seat Leaves seat when remaining seated is expected Runs about or climbs in inappropriate situations Has difficulty playing quietly Is often "on the go," acts as if "driven by a motor," talks excessively

13. Blurts out answers before questions have been completed Has difficulty awaiting turn Interrupts or intrudes on others (butts into conversations or games)

14. 3) ADHD combined Presentation Clients with both inattention, hyperactive- impulse symptoms

15. Diagnostic tests History collection Physical examination Mental status examination Neurological examination Assessing Developmental milestone Investigations DSM Diagnostic criteria

16. DSM Diagnostic criteria Five or more symptoms of inattention and/or ≥5 symptoms of hyperactivity/impulsivity must have persisted for ≥6 months to a degree that is inconsistent with the developmental level and negatively impacts social and academic/occupational activities. Several symptoms (inattentive or hyperactive/impulsive) were present before the age of 12 years. Several symptoms (inattentive or hyperactive/impulsive) must be present in ≥2 settings ( eg , at home, school, or work; with friends or relatives; in other activities).

17. There is clear evidence that the symptoms interfere with or reduce the quality of social, academic, or occupational functioning. Symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder, and are not better explained by another mental disorder ( eg , mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication, or withdrawal).

18. TREATMENT PHARMACOTHERAPY Stimulant medication Dextroamphitamine 2.5 – 20 mg/day Methylphenidate 5 – 60 mg /day 2) Antidepressants Tricyclic Antidepressants ( Bupropion, Imipramine) Monoamine oxidase inhibitors (Phenelzine) Selective serotonin reuptake inhibitors. (Citalopram, Fluoxetine)

19. BEHAVIOURAL THERAPY

20. NURSING MANAGEMENT

21. NURSING DIAGNOSIS - 1 Risk for violence towards self and others related to impulsive and accident prone behaviour as evidenced by hyperactivity Interventions Assessment Close supervision Safe environment Remove hazardous objects Identify deliberate behaviour and teach consequences Psychotherapy Medication , anti psychotics, sedatives.

22. Non compliance with task expectations related to low frustration tolerance and short attention span as evidenced by inability to complete the task. Interventions Assess the clients impulse behaviour Provide an environment for task effort that is free of distraction Provide assistance Simple task Rewarding each step completion NURSING DIAGNOSIS - 2

23. Impaired social interaction related to intrusive and immature behaviour as evidenced by excessive talk to strangers. D evelop trusting relationship and convey acceptance separate f rom the unacceptable behavior . A ssist client to decrease stimulation and distraction by a altering environment to reduce distraction Involve the child in a music based program if available Provide group activities Psychotherapy Medication NURSING DIAGNOSIS - 3

24. Imbalanced nutrition less than body requirement related to less intake of food as evidenced by decreased appetite Defensive coping related to feelings of inadequacy and need for acceptance from others . Risk for parental role conflict related to children with attention deficit hyperactivity disorder . Disturbed family process related to have child with attention deficit hyperactivity disorder as evidenced by reducing usual communication.

25. Interventions Accept the child or individual as what he is. Consider his condition and communicate with him as an equal. Approach the child at his current level of functioning. Do not use baby talk nor direct him as to his chronological age; encourage him to express his thoughts or emotions and respond to him therapeutically. Use simple and direct instructions. You may repeat your instructions more than once and at times, you may utilize visual aids or pictures in order for him to relate well Implement scheduled routine every day. Make his routine predictable and something like ritualistic so that it will only be easy for him to grasp for his independent functioning. Avoid stimulating or distracting settings. Ensure to involve the child in his daily activities in a quiet and non-stimulating area to prevent him from becoming easily distracted and hyperactive. Give positive reinforcements.  Encourage physical activity.

26. Reference Townsend MC. Essentials of psychiatric mental health nursing. 3 rd edition. Philadelphia; F A Davis company publication.2005 Ahuja N, Vyas JN. Textbook of postgraduate psychiatry. Second edition. Jaypee publication. 2013. Sreevani R. A guide to mental health and psychiatric nursing. 3 rd edition. New Delhi: Jaypee brother medical publication.2010. Raju S M, Raju B. Psychiatry and mental health nursing. Bangaluru ; Jay pee brothers medical publications.2010

27. THANK YOY