Attention Deficit/ Hyperactivity Disorder(ADHD)

 Definition:

       ADHD is a developmental disorder characterized by inappropriate degrees of inattention, over activity and impulsive behaviour 

Causes:

Multiple factors such as 

• Genetic predisposition
• Environmental factors
• Prematurity
• Maternal drug use or exposure to environmental poisons

Signs and symptoms:

1. Difficulty paying attention
2. Frequent day dreaming
3. Frequently has problems organizing tasks or activities
4. Difficulty in following instructions
5. Frequently forgetful and loses needed items, such as books, pencils or bags
6. Always fails to finish homework and other tasks
7. Easily distracted
8. Fidgets with hands or feet or squirms in the seat
9. Talking excessively
10. Interrupting or intruding others
11. Always has trouble waiting for his or her turn

Diagnosis:

• Medical examination -to rule out other possible cause of the symptoms
• Information gathering - current medical issues, family medical history and school records
• Interviews- for family members, child's teachers or other people who know the child well
• ADHD rating scales - help to collect and evaluate information about the child

Management:

Standard treatments include

1. Medications
2. Education 
3. Training
4. Counselling

Medication:

• Stimulant drugs (psycho-stimulants) help improve the signs and symptoms.                 Eg: Methyl phenidate, Dextroamphetamine
• Other medications include Atomoxetine, Anti-depressants abd clonidine

Behaviour therapy and counseling:

1. Behaviour therapy
2. Psychotherapy
3. Parental skill training
4. Family therapy
5. Social skills training

1.Behaviour therapy: Behavior therapy is an effective treatment for attention-deficit/hyperactivity disorder (ADHD) that can improve a child’s behavior, self-control, and self-esteem. It is most effective in young children when it is delivered by parents. Experts recommend that healthcare providers refer parents of children younger than 12 years old for training in behavior therapy. For children younger than 6 years old, parent training in behavior management should be tried before prescribing ADHD medication.

       When parents become trained in behavior therapy, they learn skills and strategies to help their child with ADHD succeed at school, at home, and in relationships. Learning and practicing behavior therapy requires time and effort, but it has lasting benefits for the child and the family.

2.Psychotherapy: Psychotherapy is a type of treatment for mental health conditions and emotional difficulties. It typically involves multiple sessions of active interaction between a person and a trained professional. The nature of the sessions varies depending on the type of therapy and the goal of the treatment.

         Healthcare professionals will typically prescribe medications, such as stimulants, to treat ADHD symptoms. Combining medication with psychotherapy can be more effective than medication alone.

         A 2020 review included 53 studies on adults with ADHD. It found clear evidence that psychotherapy could reduce ADHD symptoms, with the strongest evidence for cognitive behavioral therapy (CBT).

          Another 2020 review included data on children with ADHD from 10 studies. It suggested that psychotherapy could reduce irritability and aggression in children with the condition. However, it highlighted several flaws in the studies, such as their short duration.

What is CBT?

    According to the key concepts behind CBT, distorted thoughts, emotions, and beliefs play a major role in your choices and actions.

     These automatic thoughts can lead to frustration, irritation, and other emotional distress, plus factor into mental health symptoms, like anxiety or depression.

Consider the following scenario:

     You think, “If I make a mistake, I’ll look really incompetent,” as you prepare to start an important report for work. The amount of work involved overwhelms you, and soon, your worries about completing the assignment incorrectly become a more persistent anxiety.

Before long, these thoughts and emotions can affect how you handle situations:

Anxious about making a mistake, you can’t bring yourself to start the project, so you put it aside. The deadline, of course, looms closer. As a result, you become even more worried about doing a good job with the time you have left.

The outcome of the situation can easily reinforce those unhelpful beliefs:

Waiting too long to get started leaves you with no choice but to rush through the report at the last minute. When you present the assignment, your co-workers point out a few mistakes in your data. Your supervisor later sends a terse e-mail saying they were hoping for a more thorough and accurate report

In time, these patterns usually show up across daily life — at work or school, at home, and in your relationships:

You might begin to focus more heavily on your mistakes and ignore your accomplishments, believing you can’t do anything right. But this self-doubt can make it harder to contemplate even trying.

CBT can help you learn to recognize and adjust these thoughts to more realistic beliefs that don’t get in your way:

Doing your best work is important to you. So you get started on assignments right away when you have plenty of time to do research and check your work. Your first step always involves breaking the work down into smaller tasks that feel easier to handle, so you don’t get overwhelmed.

Parent education:

• Show the child lots of affection
• Take time to enjoy the child.Try to give more positive than negative attention every day
• Find ways to improve child's self esteem and sense of discipline
• Work on organisation - help the child to keep his environment organized and uncluttered
• Use simple words and demonstrate whole giving the child directions 
• Try to keep a regular schedule for meals, naps and bedtime
• Use timeouts or appropriate consequences to discipline the child
• Be patient and keep things in perspective

Nurse's Interventions:

1. Provide environmental and physical safety measures
2. Enhance capabilities and self esteem
3. Encourage support groups for parents
4. Administer medications as prescribed
5. Instruct the child and parents regarding medication administration
6. Educate the parents in handling the child property