ATTENTION DEFICIT/HYPERACTIVITY DISORDER (ADHD)
At the end of this class, you will be able to:
1. describe ADHD,
2. discuss the signs of ADHD, and
3. relate the treatment of this disorder.
AD/HD or ADHD affects about 3% to 5% of children before they reach 7 years of age. Boys are two times more likely to get it than girls. People with ADHD are NOT able to focus on things. They have a short attention span and they often act without thinking about the results of what they are doing. These people are often over active, or hyperactive.
This problem cannot be cured. It can last the person’s whole life. Older people learn how to control it and cope with it so it may not be as bad when the person gets older as it was when they were younger. This disorder is probably due to the genes. The treatment can include behavior changes, medications, some life style changes and psychological counseling.
The Signs and Symptoms
Some of the most common are:
· Impulsive behavior. The person acts before they think. They may jump from one thing to the next thing very fast. They may interrupt other people when they are doing or saying something.
· Hyperactivity. The person just can not sit still. They are very restless. They cannot calm down and sit in one place. This may decrease as the child grows older but it can be a very bad problem when the child is expected to stay in their seat and listen quietly.
· Lack of attention. The person has troublle listening to others. They have a hard time doing what others tell them to do. They very often get off track. They have trouble getting things done. They may start things but they do not finish them.
All of these signs make school, friends and home life a problem for these children. Some children have all of these signs. Some may only have one sign. Some may have one sign more than another. ADHD can occur alone or with other things like:
Depression and deep sadness
A high level of anxiety and being nervous
A conduct disorder. The person may lie, steal and have temper tantrums. They may fight and hit other people.
Being very watchful to stay awake and alert. The person may try to stay awake, alert and active by being overly watchful of their tiredness by being over active. They may yawn, stretch and just sit and play with things just to stay awake.
Obsessive compulsive acts.
What Causes It?
No one is really sure about what causes ADHD. Most think that there are a number of things that may lead to it. Some of these things are:
Genes. Some people are just born with it.
Diet. Food coloring and other things that are added to food.
Smoking. Mothers that smoke during pregnancy may affect the baby before it is born.
How Does Someone Know if They Have ADHD?
There are no medical tests to find out if a person has it. Doctors diagnose it based on the signs that the person has. The signs that the doctor looks for are:
not paying attention to details and making mistakes
not being able to stay on task because the person can not pay attention
not paying attention to what another person is saying
not following instructions
trouble getting oneself organized
dislike for homework and school because these things take mental effort
the person who loses things needed for tasks. For example, they may not be able to find a pencil for homework
forgeting simple things while doing daily activities
being easily distracted
being over active or hyperactive
squirming in the seat and figeting with feet and hands
getting up and down off the seat when the person should remain sitting
trouble with playing and enjoying a game or playing with others
not waiting one’s turn
interrupting others when they are talking or playing a game
What are the Types of ADHD?
There are three types. Each type has more of one sign than the other signs of ADHD. These types are:
Mostly hyperactive-impulsive. This type has mostly hyperactivity. This type does NOT have a lot of inattention but some of it may be present.
Mostly inattentive. This type does NOT have a lot of impulsiveness or hyperactivity but some of it may be present. These children do not act out as much as the first type and they also act better with other children than the first type. Their biggest problem is that they are not able to pay attention. They have a short attention span.
Combined form. Most children have this type. These children have the signs of the first two types.
How is ADHD Treated?
It is treated with medicines, therapy, education and a combination of all three things.
The most common type of medicine that is used to treat ADHD is called a "stimulant." Although it may seem unusual to treat ADHD and overactivity with a stimulant, it actually calms down the child with this problem. Other non-stimulant drugs are also used. The goal is to low the hyperactivity and to help the child to focus, learn and do the work and things that they should be able to do.
All children are different. A medicine that works for one child may not always work for another. It is often necessary for the doctor to try out different ones until they find one that works best for the child and one with the least side effects.
Some of these medicines are taken a couple times a day, others are long acting and need to be taken only once a day. They come in pill form, liquid form, as a capsule and as a patch.
Some of the most common side effects of these drugs are decreased appetite, sleep problems, anxiety, irritability, stomach aches, a lack of emotion, and headaches. Most of these side effects are minor and they may also go away over time as the child continues to take the medicine. The doctor, may at times, lower the dosage to decrease the side effects.
You should do these things when you are caring for a child that has these side effects.
Decreased appetite. Help the child to eat good, complete, healthy meals. Monitor the child’s weight. Offer them as many healthy food choices that you can.
Sleep problems. Keep the sleep time and the sleep routine the same each day. Relax the child. Try soft music, quiet activities, like reading a bed time story, and warm milk.
These drugs do not cure ADHD. Rather, they control the signs. They help the child to pay more attention in school, therefore, they should be able to learn better. They will be able to do their homework better as well. They may also make more friends because they are able to play better with others.
There are different types of therapy that are used for ADHD. Some aim to change the child’s behavior. The child will be helped to get organized and to do their school work. They will be helped to work out hard and difficult things. The child will also learn to monitor one’s own actions, like anger and acting out, before thinking. Parents, teachers and caregivers should reward the child with praise when they control their anger, wait for their own turn, share their toys, do their schoolwork, and follow the rules.
Both children and their families can benefit from therapy.
How to Help Children with ADHD
All people, including parents, teachers, nursing assistants and others, that work with children with ADHD must understand the child and their problem. They must all work together as a team to help the child to improve and do to well in school. They must also help the child to develop new skills, attitudes, and ways of acting with others in school and in other situations. Special, individual learning plans are put into place for these students.
This team must work out a reward system for good behavior. They must also work out and follow the things, like “time out”, that will be used when the child is not acting in the right way. These things must be done right after the action. For example, if the child waits their turn for the restroom in school, the teacher should say. “Tommy, that was very good. You waited for your turn. Thank you.”. And, if the child pushes another child or jumps around in the classroom, the teacher should say, “Tommy, you are not making good choices today. Please take a “time out”. Rewards and correction must happen immediately after the good or bad act without any delay. The child must learn to associate the good behavior with the reward or praise and they must also attach the poor behavior with the “time out” consequence.
We should also try to make situations more positive so that the child can do well. For example, large tasks should be broken down into small steps so the child does not become angry or distracted. We can also arrange play groups with smaller, rather than larger, groups of children so the child does not get over stimulated.
Some other tips for these children are:
Keep the same routine every day
Have time each day for school, homework, outdoor play and exercise
Organize. Have a special place for school supplies, toys, clothes, etc.
Reward good behavior as soon as it happens
Correct poor behavior as soon as it happens
What Other Problems Are Also Seen with ADHD?
Some children with ADHD also have another illness or condition. They may have one or more of these:
Learning disability. The child may not be able to understand some words and sounds. The child may have a lot of trouble in school with reading, spelling, math and writing skills.
Being stubborn. These children may be very stubborn. They may rebel and argue with parents, teachers, other children and those that provide them with care.
A conduct disorder. The child may lie, fight, bully and steal. They may break or damage things that belong to other people or children. As they grow older, they may start to use drugs and get into trouble with the police.
Bipolar disorder. These children will have great mood swings from highs to lows.
Tourette syndrome. The child may have nervous tics and they may repeat certain things like blinking, over and over again without any control. This disorder can be treated with medicine.
Do Teens with ADHD Have Special Needs?
Most children with ADHD will continue to have the signs and symptoms as they become a teen. Some children, however, are not diagnosed with ADHD until they get to this age because the have not had poor behavior but, instead, have only been inattentive. It is often discovered in teens when the school work becomes more difficult at this age and the person is not able to keep up with the schoolwork any longer as they used to.Teen years are difficult for all children but it is especially hard for teens with ADHD.
As children with ADHD grow older and become a teenager, they often rebel and stop taking the medicines that have helped them in the past. They may also not stay focused. Their friends become more important to them than sticking with the routine that they have followed for years. They want to be independent of their parents. They want to be accepted by their friends. They want to be like their friends who may not have ADHD. At times, they may break rules and break their routine. Again, it is important to reward good behavior and to correct poor behavior and poor choices. Rules and routines have to be clear and they have to followed consistently.
Most teenagers take chances and risks. They are more likely than other age groups to do risky behaviors, incluing reckless driving. The problem is even worse with teenagers with ADHD. Teens with ADHD have four times as many car accidents as those who do not have ADHD. They are also more likely to cause injury. They also get more speeding tickets than other teens their age.
Do Adults Have ADHD?
Many children with ADHD continue to have it as they grow older and become an adult. Also, there are many adults who have the disorder that never knew thay had it when they were younger. It may have been missed when they were a child but the person themselves may have seen signs of it when they were a child and as they grow older into adulthood. They may find it hard to stick with a job. They may find it hard to be organized and to remember things. These people may have a hard time getting up in the morning and getting to work on time. They may also have trouble on the job because they can not do as well as the other people that they work with.
Some adults are somewhat relieved to learn from their doctor that they have ADHD because they may have thought for a long time that something was wrong. They may have had a lot of trouble in school but nobody could ever figure out why. Now, as adults, they know why they have always had these problems if they are diagnosed with ADHD as an adult.
Adults with this disorder are treated in the same way as children with this disorder, using a combination of medicine and therapy.
ADHD is very common in our country. This disorder cannot be cured, but it can be controlled so that the affected child, and adult, can cope with life and be successful and happy.
Hockenberry, Marilyn J. and David Wilson. (2010). Wong's Essentials of Pediatric Nursing. 8th Edition. Elsevier Mosby.
Kee, Joyce LeFever and Evelyn Hayes. (2009). Pharmacology: A Nursing Process Approach 6th Edition. Saunders Elsevier.
National Institute of Mental Health (2010). “Attention Deficit Hyperactivity Disorder (ADHD)”. [online]. http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/complete-index.shtml
Copyright © 2010 Alene Burke
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