Wong 16: Attention Deficit/Hyperactivity Disorder

Define Attention-Deficit/Hyperactivity Disorder (ADHD).

ADHD refers to developmentally inappropriate degrees of inattention, impulsiveness, and hyperactivity.

Explain the importance of early identification of ADHD in children.

Early identification is crucial because ADHD significantly interferes with emotional and psychological development.

Describe the potential risks associated with ADHD in children.

Children with ADHD are at greater risk for conduct disorders, oppositional defiant disorders, depression, anxiety disorders, and developmental disorders.

How do the behaviors of children with ADHD differ from typical child behavior?

The difference lies in the quality of motor activity and the developmentally inappropriate levels of inattention, impulsivity, and hyperactivity.

What are the clinical manifestations of ADHD?

Manifestations may be numerous or few, mild or severe, and vary with the child's developmental level, often apparent in educational and family settings.

Explain the role of standardized rating scales in diagnosing ADHD.

Diagnosis should incorporate standardized rating scales based on DSM-5 criteria and information from multiple sources like parents and teachers.

What are the current DSM-5 diagnostic criteria for ADHD?

Criteria include at least six symptoms of inattention or hyperactivity-impulsivity before age 12, present for at least 6 months, occurring in more than one setting, and impairing functioning.

Describe the manifestation of distractibility in children with ADHD.

Distractibility can arise from both external and internal stimuli, affecting the child's ability to focus.

How does selective attention manifest in children with ADHD?

Children often struggle to attend to nonpreferred tasks, such as chores or homework, indicating difficulties with selective attention.

What is a major clinical manifestation of ADHD observed at an early age?

A major clinical manifestation is distractibility, which can be evident in various settings.

Discuss the variability of ADHD symptoms among affected children.

Each child with ADHD exhibits different symptoms and behaviors, making individual assessment essential.

What is the significance of the age threshold in ADHD diagnosis according to DSM-5?

Symptoms must appear before age 12 to meet the diagnostic criteria for ADHD.

How do ADHD symptoms impact a child's self-concept?

Negative feedback from others due to ADHD behaviors can adversely affect a child's self-concept.

What is the relationship between ADHD and learning disabilities?

Learning disabilities may not become evident until the child enters school, even though behavioral manifestations are apparent earlier.

Describe the characteristics of a child with ADHD.

Children with ADHD may not consider the consequences of their behavior, take excessive physical risks, and demonstrate inappropriate social skills.

Explain the two main presentations of ADHD.

ADHD can present as either inattentive presentation, characterized by sufficient symptoms of inattention without hyperactivity-impulsivity, or hyperactive-impulsive presentation, characterized by sufficient symptoms of hyperactivity-impulsivity without inattention.

How is ADHD diagnosed?

ADHD diagnosis requires a thorough multidisciplinary evaluation involving pediatric health care providers, psychologists, and educators, assessing the child's behavior across various settings.

Define comorbidities in the context of ADHD.

Comorbidities refer to additional disorders that may occur alongside ADHD, such as anxiety, depression, oppositional defiant disorder, conduct disorders, language and learning disorders, tics, and sleep apnea.

What is the role of behavioral checklists in ADHD assessment?

Behavioral checklists and adaptive scales completed by caregivers and educators help measure social adaptive functioning and provide benchmarks for evaluating behavioral changes during therapy.

How does a complete medical history contribute to ADHD diagnosis?

A complete medical and developmental history helps clinicians determine if the child's behavior is age-appropriate or problematic, guiding the diagnostic process.

Explain the importance of a multidisciplinary approach in evaluating ADHD.

A multidisciplinary approach ensures comprehensive assessment by incorporating insights from various professionals, including pediatricians, psychologists, and educators, to accurately evaluate the child's behavior.

What types of evaluations are included in the diagnostic process for ADHD?

The diagnostic process includes a physical examination, vision and hearing screening, neurologic evaluation, psychological testing, and gathering behavior descriptions from multiple observers.

Describe the significance of psychologic testing in ADHD evaluation.

Psychologic testing helps identify visual-perceptual difficulties, spatial organization problems, and assesses the child's intelligence and achievement levels.

How do clinicians rule out other disorders when diagnosing ADHD?

Clinicians rule out other psychiatric disorders, medical problems, and traumatic experiences by conducting thorough evaluations and assessments to ensure accurate diagnosis.

Describe the first-line treatment for ADHD according to evidence.

Behavioral therapy is supported as the first-line treatment for ADHD.

Explain the role of behavioral therapy in managing ADHD.

Behavioral therapy focuses on preventing undesired behavior and helps families identify appropriate contingencies and reward systems to meet the child's needs.

How does behavioral therapy improve functioning in children with ADHD?

It can lead to improved functioning at home, in school, and in social situations.

Define the initial approach to medication for children with ADHD aged 5 years and over.

The first choice of medication is methylphenidate, either long acting or immediate release.

What should be done if symptoms of ADHD are not sufficiently reduced by methylphenidate?

A switch to lisdexamfetamine should be considered.

Describe the process of medication dosage adjustment for children with ADHD.

Children are given a small initial dosage, which is gradually increased until the desired response is achieved.

What side effects should be monitored in children receiving stimulant medication for ADHD?

Side effects include appetite loss, abdominal pain, headaches, sleep disturbances, and growth velocity.

Explain why stimulants should be avoided in certain children with ADHD.

Stimulants should be avoided in children with a history of ticlike behaviors, a family history of Tourette syndrome, or ADHD combined with Tourette syndrome, as they may exacerbate tics.

What are some alternative medications that may be used as adjunct therapy for ADHD?

Tricyclic antidepressants and extended-release clonidine may be used, especially for children with coexisting conditions like sleep disturbances.

How are stimulants classified in terms of prescription and storage?

Stimulants are controlled drugs, requiring specific prescribing and storage requirements.

What advantages do modified-release, once-daily preparations of ADHD medication offer?

They provide convenience and better adherence to the treatment regimen.

What additional interventions can be included in the therapeutic management of ADHD?

Additional interventions include skill building, social skills training, and intensive summer-camp treatment programs.

How do parents contribute to the success of their child with ADHD in behavioral therapy?

Through collaborative teamwork, parents learn techniques to help the child become more successful at home and in school.

What is the importance of family education and counseling in ADHD treatment?

Family education and counseling help families understand ADHD and develop effective strategies to support their child.

Describe the role of modified-release formulas in ADHD treatment.

Modified-release formulas help reduce stigma as they can be taken outside of school and eliminate the risk of misuse and diversion.

Explain the importance of regular reevaluation in ADHD medication management.

Regular reevaluation is essential to determine medication effectiveness, detect side effects, monitor development and health status, and assess family interaction.

Define multimodal treatment in the context of ADHD.

Multimodal treatment involves the use of pharmacotherapy, behavioral intervention, and close follow-up with feedback from school personnel, proving to be more effective than intensive behavioral treatment alone.

How does ADHD coaching contribute to treatment for individuals with ADHD?

ADHD coaching empowers individuals to manage their attention, hyperactivity, and impulsivity by developing self-awareness and strategies.

What strategies can families use to modify the environment for children with ADHD?

Families can create a more structured environment, ensure consistency between home and school, and teach organizational skills to help children succeed.

Explain the significance of consistency in managing ADHD.

Consistency between families and teachers in reinforcing the same goals is essential for children with ADHD to thrive.

Describe some interventions that can help children with ADHD succeed academically.

Helpful interventions include creating organizational charts, reducing distractions during homework, and modeling positive behaviors and problem-solving.

How can parents assist their children with ADHD in making appropriate choices?

Parents can encourage children to take responsibility for their actions and help them develop better decision-making skills.

What is the Pediatric Quality Indicator related to ADHD medication follow-up?

The Pediatric Quality Indicator provides guidelines for the follow-up of children taking ADHD medications, ensuring proper monitoring and evaluation.

Discuss the importance of monitoring growth and blood pressure in children on ADHD medications.

Monitoring growth and blood pressure is crucial to assess the overall health status and potential side effects of ADHD medications.

Describe the ideal classroom environment for children with ADHD.

Children with ADHD thrive in an orderly, predictable, and consistent classroom environment that has clear and consistent rules.

How should homework and classroom assignments be adjusted for children with ADHD?

Homework and classroom assignments may need to be reduced, and more time should be allotted for tests to allow the child to complete them.

Explain the importance of visual references in instructions for children with ADHD.

Verbal instructions should be accompanied by visual references, such as written instructions on the blackboard, to enhance understanding.

What is the recommended timing for teaching academic subjects to children with ADHD?

Academic subjects should be taught in the morning when the child is experiencing the effects of their morning dose of medication.

How can teachers maintain the attention and interest of children with ADHD during classroom activities?

Teachers can intermix low-interest and high-interest classroom activities to maintain the child's attention and interest.

What role do breaks play in the classroom for children with ADHD?

Regular and frequent breaks in activity are helpful because sitting in one place for an extended time may be difficult for children with ADHD.

How can computers assist children with ADHD?

Computers can be helpful for children who have difficulty with written assignments and fine motor skills.

Define the purpose of programs for children with learning disabilities.

The purpose of programs for children with learning disabilities is to assist them toward more successful achievement, personal adjustment, and retention in the regular classroom.

What is the prognosis for children with ADHD with appropriate intervention?

With appropriate intervention, ADHD is relatively stable through early adolescence for most children, although some may carry symptoms into adulthood.

How do nurses contribute to the management of children with ADHD?

Nurses, especially school nurses, participate in planning and implementing therapeutic regimens, evaluating therapy effectiveness, and coordinating services between health and education professionals.

What is the role of school nurses in supporting children with ADHD?

School nurses understand the child's special needs and work with teachers to provide support and guidance during the child's development.

Explain the significance of self-contained classes for children with learning disabilities.

Self-contained classes limited to six to eight children provide specialized attention and support for children with learning disabilities.

What is the function of mobile consultants in the context of ADHD and learning disabilities?

Mobile consultants move from room to room to provide assistance to teachers and children, enhancing support for those with ADHD and learning disabilities.

Describe the long-term role of community nurses in managing ADHD.

Community nurses work with families and school personnel on a long-term basis to help plan, implement, and evaluate therapeutic regimens for children with ADHD.

Describe the initial steps in management for a child diagnosed with a disorder.

Management begins with explaining the diagnosis to the parents and the child, including the nature of the problem and the underlying central nervous system basis for the disorder.

Explain the importance of informing parents about medication side effects.

Parents need to be informed of the possible side effects of medications to make informed decisions and manage their child's treatment effectively.

How can decreased appetite be managed in children taking psychostimulants?

Decreased appetite can be managed by giving psychostimulants with or after meals, encouraging nutritious snacks in the evening, and serving frequent small meals.

What strategies can help reduce sleeplessness in children taking medication?

Administering medication early in the day can help reduce sleeplessness.

Define the impact of tricyclic antidepressants on dental health in children.

Children taking tricyclic antidepressants may experience a dramatic increase in dental caries due to the anticholinergic action of the drugs, which increases saliva viscosity and causes dry mouth.

Explain the nursing functions related to dental hygiene for children on tricyclic antidepressants.

Nursing functions include emphasizing rigorous dental hygiene, home fluoride treatments, regular dentist visits, limiting refined carbohydrates, and using artificial saliva.

How can parents address concerns about addiction to psychostimulants or antidepressants?

Parents should be informed that while these drugs have potential for abuse, most children with ADHD are not interested in abusing them, but they should monitor for psychological dependence and keep medications safely stored.

What is the significance of understanding the prognosis and treatment plan for parents?

Understanding the prognosis and treatment plan helps parents carry out the recommended therapy and manage environmental changes effectively.

Describe the role of reading materials for families dealing with a child's disorder.

Reading materials can provide valuable information to help the child and family understand the disorder and its effects.

How does the effect of psychostimulants differ in children with ADHD compared to normal individuals?

In children with ADHD, the effect of psychostimulants is opposite to that produced in normal individuals, which reduces their interest in abusing the drugs.