ADHD
INTRODUCTION and
MEANING:-
Attention deficit hyperactivity disorder (ADHD) similar to hyperkinetic disorder in the ICD10, is a psychiatric
disorder of the neurodevelopmental type in which there are significant problems
of attention,
hyperactivity, or acting impulsively that are not appropriate for a
person's age. It is usually not diagnosed before age of 4 year.
DEFINITION:
ADHD is behavior
disorder that is characterized by hyperactivity, impulsiveness, inattention or
a combination of those would be expected that are more frequent and severe than
would be expected for the age.
EPIDEMIOLOGY:-
ADHD in the United
states have varied from 2 to 20 percent of grade school children. It is more
common in boys than girls by a ratio of 2:1 or 4:1 and may occur in as many as
7 to 10 percent of school age children. And about 60 to 70 percent of the case
ADHD persist will subsequently meet the criteria for antisocial personality
disorder with adults. It affects the home, school, and community life of 3-9%
of schoolgoing children worldwide.
One research
conducted in Tamil Nadu that's find The prevalence of ADHD among primary school
children was found to be 11.32%. Prevalence was found to be Higher among the
males (66.7%) as compared to that of females (33.3%). The prevalence among
lower socio-economic group was found to be 16.33% and that among middle
socio-economic group was 6.84%. The prevalence was highest in the age group 9
and 10 years and higher prevalence among the males than the females.
The study name was
Prevalence of Attention Deficit Hyperactivity Disorder in primary school
children by Jyothsna Akam Venkata, Anuja S. Panicker
Department of
Psychiatry, P. S. G. Institute of Medical Sciences and Research, Coimbatore,
Tamil Nadu, India.
ETIOLOGY:-
Genetics:
-A large number of parents of hyperactivity children showed signs of
hyperactivity during their own childhood.
Siblings of
hyperactivity children have about twice the risk of having the disorder as
those in the general population.
Children with ADHD
are at higher risk of developing conduct disorders and alcohol use disorders
and antisocial personality disorder are more common in their parents than in
those in the general population.
Biochemical:
- Abnormal levels of dopamine, norepinephrine and serotonin have been
implicated as a cause of ADHD. Abnormal level of these neurotransmitters may be
associated with the symptoms of inattention, hyperactivity, impulsivity, mood
and aggression observed with disorder.
Perinatal
factors: - In this factor implicated with problem pregnancies and difficult
deliveries, maternal smoking and use of alcohol or other drug during pregnancy,
exposure during pregnancy to environmental toxins.
Psychosocial factors: - A disorganized
environment or a disruption in family equilibrium may contribute to ADHD. A
high degree of psychosocial stress, maternal mental disorder, paternal
criminality, low socioeconomic status and unstable foster care have been shown
to increase the risk of ADHD.
Types:
1.Attention deficit hyperactivity Inattentive: - Inattention but not enough (at least 6 out of 9 for children less
than 18 years old) symptoms. At least
six symptoms of inattention have persisted for at least 6 months. In this sub
type of disorder has difficulty paying attention, does not listen when spoken
to, difficulty organizing tasks and activities.
2.Attention deficit hyperactivity Impulsive: - In this sub type is used if at least six symptoms of hyperactivity
impulsivity ( but fewer than six symptoms of inattention) have persisted for at
least six month . In this disorder trouble sitting still, cannot play quietly,
talks excessively, blurts answer before question are complete, has difficulty
in
3.Attention deficit hyperactivity combined type: - displays a combination of behaviors associated with the above two
types. in this disorder six symptoms of both disorder for at least six month.
Most of the children and adolescents with the disorder have combined
Clinical feature:-
Inattention
This must include
at least 6 of the following symptoms of inattention that must have persisted
for at least 6 months to a degree that is maladaptive and inconsistent with
developmental level:
1.
Often fails to give close
attention to details or makes careless mistakes in schoolwork, work, or other
activities
2.
Often has difficulty sustaining
attention in tasks or play activities
3.
Often does not seem to listen
to what is being said
4.
Often does not follow through
on and fails to finish schoolwork, chores, or duties in the workplace (not due
to oppositional behavior or failure to understand insuuctions)
5.
Often has difficulties
organizing tasks and activities
6.
Often avoids or strongly
dislikes tasks (such as schoolwork or homework) that require sustained mental
effort
7.
Often loses things necessary
for tasks or activities (school assignments, pencils, books, tools, or toys)
8.
Often is easily distracted by extraneous
stimuli
9.
Often forgetful in daily
activities
Hyperactivity/impulsivity
must include at
least 4 of the following symptoms of hyperactivity-impulsivity that must have
persisted for at least 6 months to a degree that is maladaptive and
inconsistent with developmental level:
1.
Hyperactivity evidenced by
fidgeting with hands or feet, squirming in seat
2.
Hyperactivity evidenced bÿ
leaving seat in classroom or in other situations in which remaining seated is
expected
3.
Hyperactivity evidenced by
running about or climbing excessively in situations where this behavior is
inappropriate (in adolescents or adults, this may be limited to subjective
feelings of restlessness)
4.
Hyperactivity evidenced by difficulty
playing or engaging in leisure activities quietly
5.
Impulsivity evidenced by
blurting out answers to questions before the questions have been completed.
6.
Impulsivity evidenced by
showing difficulty waiting in lines or awaiting turn in games or group
situations
Other
·
Onset is not later than age 7
years.
·
Symptoms must be present in 2
or more situations, such as school, work, or home.
·
The disturbance causes
clinically significant distress or impairment in social, academic, or occupational functioning.
·
Disorder does not occur
exclusively during the course of a pervasive developmental disorder,
schizophrenia, or other psychotic disorder and is not better accounted for by
mood, anxiety, dissociative, or personality disorder.
Medical management:
CNS Stimulants:-
l. Amphetamines: -
Dextroamphetamine sulfate , lisdezamphetamine
2. Amphetamine
mixture
Alpha agonists :-
Clonidine and Guanfacine
Action: - CNS
stimulants increase levels of neurotransmitters
in the CNS. They produce CNS and
respiratory stimulation, dilated pupils, increased motor activity and mental
alertness, diminished sense of fatigue and brighter spirits.
Central nervous
system stimulants are the first choice of agents in that they have been shown
to have the greatest efficacy with generally mild tolerable side effects.
Side effects
Overstimulation, restlessness, insomnia,
Palpitation, tachycardia or bradycardia, Anorexia, weight loss, Tolerance,
physical and psychological dependence,Nausea, vomiting, constipation, dry
mouth, sedation, Potential for seizures, Liver damage and rebound syndrome
Nursing management: Nursing diagnosis:-
1.Risk for injury
related to impulsive and accident prone behaviour and the inability to perceive
self-harm
Nursing actions:-
Ensure that environment is safe
·
Identify and limit behaviors
that put child at risk for injury
·
Provide necessary supervision
to prevent injury during therapeutic activities
Nursing diagnosis:-
2.Impaired social
interaction related to intrusive and immature behavior
Nursing actions:-
·
Develop a trusting relationship
·
Discuss with client which
behaviors are and are not acceptable
·
Employ consequences for
unacceptable behavior
·
Provide group situations for
client
Nursing diagnosis:-
3.Low self-esteem
related to Dysfunctional family system and negative feedback
Nursing actions:-
·
Ensure that goals are realistic
·
Plan activities that provide
opportunity for success
·
Convey unconditional acceptance
and positive regard
·
Give positive reinforcement for
achievements
Nursing diagnosis:-
4. Noncompliance
related to low frustration tolerance and short attention span
Nursing actions:-
·
Reduce environmental
distraction
·
Provide simple, concrete
instructions
·
Establish goals for completion
of tasks in steps, reward each step completion
·
Encourage and reward independent
achievement
COMMENTS