ATTENTION DEFICIT HYPER ACTIVITY DISORDER

2. ATTENTION DEFICIT HYPER
ACTIVITY DISORDER

3. DEFINITION
 “The essential feature of ADHD is
persistent pattern of inattention and /or
hyperactivity or impulsivity that is more
frequent or severe than is typically
observed in individuals at a comparable
level of development” {APA, 2000}

4. IMPULSIVENESS
 trait of acting without reflection and without
thought to the consequences of the behavior .
 An abrupt inclination to act ( and the inability
to resist acting ) on certain behavioral urges.

5. EPIDEMIOLOGY
 Onset : Less than 4yrs
 Frequency of disorder is recognized when
the child enters the school
 Gender : 4 to 9 times more common in boys
than in girls
 Occur as many as 3-7 % in school going
children

6. ETIOLOGY
 BIOLOGICAL INFLUENCE
 Genetic factors:
 More in monozygotic twins than dizygotic
twins.
 Siblings of hyperactive children

7. ETIOLOGY
 Biochemical theory:
 Deficit of dopamine and
norepinephrine.

8. ETIOLOGY
 Pre, peri and postnatal factors
 Prenatal toxic exposure
 Mechanical insult to fetal nervous system
 Prematurity
 Fetal distress
 Prolonged labor
 Perinatal asphyxia
 Postnatal infections
 CNS abnormalities.

9. ETIOLOGY
 ENVIRONMENTAL INFLUENCES:
 Environmental lead
 Food additives
 Coloring preservatives

10. ETIOLOGY
 PSYCHOSOCIAL FACTORS:
 Prolonged emotional deprivation
 Stressful psychic events
 Disruption of family equilibrium

11. CLINICAL FEATURES
 Sensitive to stimuli
 Easily upset by noise, light, temperature
and other environmental changes.
 Short attention span
 Easily distractible
 Failure to finish task
 Impulsivity
 Memory and thinking deficits
 Specific learning disabilities.

12. CLINICAL FEATURES
 In school
 Restless.
 Answer only the first few questions
 Answer to questions before they have been completed
 Unable to wait to be called on in school and may
respond before everyone else.
 Has difficulty awaiting turn in games or group
situations
 Often loses things necessary for tasks or activities at
school

13. CLINICAL FEATURES
 In home
 Explosive or irritable
 Emotionally labile and easily set off to laughter or
tears
 Unpredictable mood
 Inability to delay gratification
 Often talks excessively
 Engage in physically dangerous activities .

14. DIAGNOSIS
 Complete medical evaluation
 A psychiatric evaluation to assess intellectual
ability, academic achievement and potential
learning disorder problem.
 Detailed prenatal history
 Early developmental history
 Direct observation
 Teachers school report, parents report.

15. MEDICAL MANAGEMENT
 Central nervous system stimulants are
used for ADHD. Although these drugs are
called stimulants, they actually have a
calming effect on people with ADHD

16. MEDICAL MANAGEMENT
Dextroamphitamine { Dexadrine}
PO{ Children: 3- 5yrs } : 2.5 mg /day
6yrs or older: 5 mg / day
Pemoline {Cylert}
PO{ 6yr or more } Initial dose : 37.5 mg /day
Methylphenydate
PO{children 6yrs or older } :5- 10 mg /day .

17. MEDICAL MANAGEMENT
Atomoxetine
 PO for children and adults weighing 70 kg:
Dose 40 to 80 mg daily, If weight less than
70 kg , .5mg /kg /day

18. MEDICAL MANAGEMENT
Antidepressants:
 Bupropion PO 6yrs or more : 3mg /kg /day
 Imipramine ; PO 6yr or more : 1mg /kg
Antipsychotics:
Clonidine:

19. PSYCHOLOGICAL THERAPIES
 Behavior therapy
 Social skill training
 Family education

20. NURSING MANAGEMENT
 RISK FOR INJURY R/T IMPULSIVE AND ACCIDENT
PRONE BEHAVIOR AND INABILITY TO PERCEIVE
SELF HARM
 IMPAIRED SOCIAL INTERACTION R/T INTRUSIVE
AND IMMATURE BEHAVIOR
 LOW SELF ESTEEM R/T DYSFUNCTIONAL FAMILY
SYSTEM AND NEGATIVE FEED BACK
 NONCOMPLIANCE WITH TASK EXPECTATIONS R/T
LOW FRUSTRATION TOLERANCE AND SHORT
ATTENTION SPAN.