Attention-Deficit/Hyperactivity Disorder

Question 1

Pathophysiology of ADHD

Answer 1

Exact mechanism is unknown

Alleles of dopamine genes may alter dopamine transmission in the neural networks

During fetal development, bouts of hypoxia and hypotension could selectively damage neurons located in some of the critical regions of the anatomic network

Question 2

Risk Factors for ADHD

Answer 2

1. Family History
2. Comorbid conditions such as learning disabilities, mood disorders, oppositional defiant disorder and conduct disorder
3. Head Trauma
4. Lead Exposure
5. Cigarette Smoke
6. Prematurity
7. Low birthweight

Question 3

Signs and Symptoms of ADHD

Answer 3

1. Impulsivity
2. Hyperactivity
3. Inattention

Question 4

Symptoms of Inattention

Answer 4

1. Making careless mistakes in schoolwork
2. Struggling to sustain attention
3. Appearing to not be listening
4. Failing to follow through with or finish activities
5. Difficulty with organization
6. Avoiding tasks that require sustained mental effort
7. Being distracted by extraneous stimuli
8. Forgetfulness
9. Losing things required to complete a task

Question 5

Symptoms of Hyperactivity and Impulsivity

Answer 5

1. Fidgeting (tapping of hands or feet)
2. Inability to sit for sustained periods
3. Excessive running or climbing
4. Difficulty playing quietly
5. Seemingly motor-driven actions
6. Excessive Talking
7. Interrupting
8. Inability to wait patiently
9. Blurting out answers before questions are completed

Question 6

Complications fo ADHD

Answer 6

1. Emotional and social isolation
2. Poor nutrition

Question 7

Nursing Assessment: Health History

Answer 7

1. Elicit a description of the behavioral issue or school performance problem
2. Determine if there is a family history of ADHD
3. Ask about school behavior
   (school-age: unable to stay on task, talks out of turn, leaves desk frequently, neglects to complete in-class and homework assignments or forgets to turn them in) (adolescent: may be inattentive in school, poorly organized and forgetful

Question 8

Nursing Assessment: Physical Examination

Answer 8

1. Perform vision and hearing test
2. Observe the preschool child’s behavior noting (1) quickness, (2) agility, (3) fearlessness, (4) desire to touch or explore everything in the room
3. Older child or adolescent may have difficulty staying on task during the examination or change the subject frequently

Question 9

Laboratory/Diagnostic Testing

Answer 9

• No definitive lab or diagnostic test is available to identify ADHD*

A complete blood count may be performed to rule out anemia, and thyroid hormone levels may be drawn to determine whether they are normal

Question 10

Interventions for ADHD

Answer 10

1. Provide emotional support
2. Develop goals (completion of homework, improved communication, or increasing independence in self care
3. Advocate for their child’s needs through public school system (IEP)
4. Teach about behavioral techniques (time-out, positive reinforcement, rewards or privilege withdrawal or token system
5. Refer to support groups
6. Medication administration (given in morning, with or after meal)

Question 11

Challenges with ADHD

Answer 11

1. Oppositional defiant disorder
2. Conduct disorder
3. Anxiety disorder
4. Depression
5. A less severe developmental disorder
6. Auditory processing disorder
7. Learning or Reading disabilities