Attention-Deficit & Disruptive Disorders

ADHD Attention Deficit Hyperactivity Disorder

Persistent pattern of inattention and or hyperactivity-impulsiveness revealed before the age of 7 years Occurs in 3 to 7 % of school-age children in US Boys > girls Idiopathic Genetic etiologic component Assoc with child neglect Lead poisoning Drug exposure in utero

Characterized by 3 behaviors:
INATTENTION IMPULSIVENESS HYPERACTIVITY

Assessment Diagnosable by 36 months of age Behavior: active or always on the go

Hyperactivity Not able to sit still long enough to finish a full meal Running to the window 10 times in 15 minutes Disorganized activity: running from back of the room to the front, to the teachers desk to their own desk

 Repetitive activities Pencil tapping Arm swinging Finger tapping Leaves an activity intently and run to the window or refrigerator unaware of why they are running

 Variability

Have good and bad moments Lose track of systems Poor school performance

 Impulsiveness

Make statements without thinking Touch objects theyre not allowed to speak and act before they think all or none reaction to stimuli Cant concentrate on problem at hand

Difficulty with right & left, before & after, in front of, in back of and yesterday and tomorrow Difficulty forming common letters b & d Difficulty using prepositions and conjunctions correctly Difficulty to read Difficulty in arithmetic Spelling is difficult W/O INTELLIGENCE DEFICIT

 PE:

Inability to use pencil and scissors well NEUROLOGIC EXAMINATION w/o Difficulty performing finger-tonose test, rapid hand movements mirroring Cerebellar difficulty Identify one touch but not 2 simultaneous touch

 Not normal: Grapesthesia Stereognosis Choreiform movements Unilateral babinski reflex or strabismus Scatter pattern on performance and verbal portions

ADHD Diagnostic Evaluation

Physical examination Parent-rated child behavior scales Teacher-rated child behavior scales Parent and child interviews Parent self report measures Parent self-report measures Clinic-based psychological test Review of prior school and medical reports Intelligence testing (IQ tests) and educational achievement testing

Possible Nursing Diagnosis

Impaired Social Interaction: Insufficient or excessive quantity or ineffective quality of social exchange.

Therapeutic Management
Environment Stable learning environment Special schooling Free of stimulating distractions Be firm, set consistent limits Offer choices for the child Assist children to reach the point of the story Punishment should follow an offense quickly Poor self esteem

 Medication Methylphenide hydrochloride (Ritalin) Family Support Frequent health visits Frequent health visits Responsive, listening ear Close parental supervision Caution against accidents e.g. burns