attention-deficit & disruptive disorders

8/13/2019 Attention-Deficit & Disruptive Disorders

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Attention-Deficit &

Disruptive Disorders


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ADHD

Attention DeficitHyperactivity

Disorder


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Persistent pattern of inattention and orhyperactivity-impulsiveness revealed before

the age of 7 years Occurs in 3 to 7 % of school-age children inUS

Boys > girls Idiopathic

Genetic etiologic component Assoc with child neglect Lead poisoning Drug exposure in utero
http://www.google.com.ph/url?sa=i&rct=j&q=adhd&source=images&cd=&cad=rja&docid=hNYxmoNKPl8JWM&tbnid=tvfcykL2WAdxzM:&ved=0CAUQjRw&url=http://www.adhd.org.nz/&ei=OagvUcX8OIaZiAfblIG4Bg&psig=AFQjCNF3j7ApWhoJ5EfHuSh0UK2RYPUAXQ&ust=1362164144865926http://www.google.com.ph/url?sa=i&rct=j&q=adhd&source=images&cd=&cad=rja&docid=hNYxmoNKPl8JWM&tbnid=tvfcykL2WAdxzM:&ved=0CAUQjRw&url=http://www.adhd.org.nz/&ei=OagvUcX8OIaZiAfblIG4Bg&psig=AFQjCNF3j7ApWhoJ5EfHuSh0UK2RYPUAXQ&ust=1362164144865926


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Characterized by 3behaviors:

INATTENTION

IMPULSIVENESS

HYPERACTIVITY


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Assessment

Diagnosable by 36 months of age

Behavior: active or always on the go


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HyperactivityNot able to sit still long enough tofinish a full meal

Running to the window 10 times in 15minutes

Disorganized activity: running fromback of the room to the front, to the

teachersdesk to their own desk


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Repetitive activitiesPencil tapping

Arm swinging

Finger tapping

Leaves an activity intently and runto the window or refrigerator

unaware of why they are running


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VariabilityHave good and bad moments

Lose track of systems

Poor school performance


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Impulsiveness

Make statements without thinking

Touch objects theyre not allowedto speak and act before they think

all or none reaction to stimuli

Cant concentrate on problem athand


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Difficulty with right & left, before & after, infront of, in back of and yesterday andtomorrow

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


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PE: Inability to use pencil and scissorswell

NEUROLOGIC EXAMINATIONw/o Difficulty performing finger-to-nose test, rapid hand movementsmirroring

Cerebellar difficultyIdentify one touch but not 2simultaneous touch


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Not normal:GrapesthesiaStereognosis

Choreiform movements

Unilateral babinski reflex orstrabismus

Scatter pattern on performance

and verbal portions


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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


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Possible Nursing Diagnosis

Impaired Social Interaction: Insufficient orexcessive quantity or ineffective quality ofsocial exchange.


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Therapeutic Management

EnvironmentStable learning environmentSpecial schooling Free of stimulating distractionsBe firm, set consistent limitsOffer choices for the childAssist children to reach the point of thestory

Punishment should follow an offensequickly

Poor self esteem


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Medication Methylphenide hydrochloride (Ritalin)

Family Support

Frequent health visitsFrequent health visits

Responsive, listening ear

Close parental supervision

Caution against accidents e.g. burns


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attention-deficit & disruptive disorders

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