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Adhd

ATTENTION DEFICIT HYPER ACTIVITY DISORDER

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Adhd

  1. 1. ATTENTION DEFICIT HYPER ACTIVITY DISORDER
  2. 2. 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}
  3. 3. 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.
  4. 4. 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
  5. 5. ETIOLOGY  BIOLOGICAL INFLUENCE  Genetic factors:  More in monozygotic twins than dizygotic twins.  Siblings of hyperactive children
  6. 6. ETIOLOGY  Biochemical theory:  Deficit of dopamine and norepinephrine.
  7. 7. 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.
  8. 8. ETIOLOGY  ENVIRONMENTAL INFLUENCES:  Environmental lead  Food additives  Coloring preservatives
  9. 9. ETIOLOGY  PSYCHOSOCIAL FACTORS:  Prolonged emotional deprivation  Stressful psychic events  Disruption of family equilibrium
  10. 10. 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.
  11. 11. 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
  12. 12. 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 .
  13. 13. 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.
  14. 14. 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
  15. 15. 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 .
  16. 16. 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
  17. 17. MEDICAL MANAGEMENT Antidepressants:  Bupropion PO 6yrs or more : 3mg /kg /day  Imipramine ; PO 6yr or more : 1mg /kg Antipsychotics: Clonidine:
  18. 18. PSYCHOLOGICAL THERAPIES  Behavior therapy  Social skill training  Family education
  19. 19. 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.

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