Chapter 22: Attention Deficit/Hyperactivity Disorder (ADHD)

Question 1

Attention-Deficit/Hyperactivity Disorder (ADHD)

Answer 1

images of the overactive, talkative child “bouncing off the walls” and always in trouble are likely portrayed
-can have attention-deficit disorder with or without hyperactivity
>category without hyperactivity usually has symptoms of distractibility

Question 2

Signs + Symptoms

Answer 2

> inattention

• often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
• difficulty sustaining attention in tasks or play activities
• often does not seem to listen when spoken to directly
• often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
• difficulty organizing tasks and activities
• often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
• often looses things necessary for tasks or activities (e.g. toys, school assignments, pencils, books, or tools)
• often easily distracted by extraneous stimuli
• often forgetful in daily activities

Question 3

Six or more of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level

Answer 3

> Hyperactivity
-often fidgets with hands or feet or squirms in seat
-often leaves seat in classroom or in other situations in which remaining seated is expected
-often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
-is often “on the go” or often acts as if “driven by a motor”
-often talks excessively
Impulsivity
-often blurts out answers before questions have been completed
-often has difficulty awaiting turn
-often interrupts or intrudes on others (e.g. butts into conversations or games)

Question 4

Impact of ADHD

Answer 4

• can be seen in much younger children; often diagnosed in early school-aged children
• have difficulty with school performance and peer interaction

Question 5

Diagnosis

Answer 5

-must meet criteria of DSM-IV
-evaluations conducted by practice nurses, physicians, and other health-care providers
-when criteria is met, final diagnosis requires evidence of the child’s behavior in a variety of settings such as a classroom, during homework, or playtime
-evidence obtained by asking parents, teachers, and other caregivers to complete rating scales about behavior
>additional information needed includes the age at onset of symptoms, duration of symptoms, and degree of impaired functioning

Question 6

Treatment

Answer 6

combination of pharmacological and psychosocial interventions
>keep in mind developmental level of child
>early intervention

Question 7

Education/ Discharge

Answer 7

• educate family in behavioral techniques for helping the child focus and maintain appropriate behaviors
• educate about pharmacological interventions
• for children, behavior therapy, rewards (sticker charts), and positive versus negative reinforcement

Question 8

Medication: ADHD

Answer 8

-stimulants most commonly used
-Ritalin and other forms of methylphenidate, amphetamine salts (Adderall), and atomoxetine (Strattera), a non-simulant medication, are used in this condition
>Methylphenidate also is prescribed in a transdermal patch form for children 6 years and older; patch designed for children who ere unable to swallow any tablets or capsules

Question 9

Characteristics of ADHD: Inattention

Answer 9

• distractibility
• inability to complete projects
• easily bored
• disorganized
• inattentiveness
• avoidance of detailed tasks
• forgetfulness

Question 10

Characteristics of ADHD: Hyperactivity or Impulsivity

Answer 10

• excessive energy and activity
• restlessness
• overactivity
• inability to sit still or stay in one place for long
• excessive talking
• poor boundaries– interrupts or intrudes
• difficulty delaying