ATTENTION DEFICIT AND DISRUPTIVE BEHAVIOR DISORDERS

By: Kristine Charisse V. Tanedo

BSN3 MSU-IIT

ATTENTION DEFICIT HYERACTIVITY DISORDER (ADHD)

-characterized by in attentiveness, over activity and impulsiveness

-common disorder, especially in boys -essential feature: persistent pattern of

in attention and hyperactivity and impulsivity

-high serotonin and norepinephrine

ONSET AND CLINICAL COURSE

SYMPTOMS: Infants: -often fussy and temperamental -have poor sleeping patterns Toddlers: -always on the go -into everything -dart back and forth -jump and climb into furniture -run through the house -cannot tolerate sedentary activities such as

listening to stories

ONSET AND CLINICAL COURSE

School Age: symptoms begin to interfere significantly with behavior and performance

-fidgets constantly -is in and out of assigned seats -make excessive noise by tapping

or playing with pencils and other objects -easily distracted by normal

environmental noises (eg: coughing) -child interrupts and blurts out

answers before questions are completed

ONSET AND CLINICAL COURSE

Adolescence: two-thirds of children dx with ADHD continue to have problems in adolescence

; possess typical impulsive behaviors -cutting classes -getting speeding tickets -failing to maintain interpersonal

relationships -adopting risk-taking behaviors such as

using drugs or alcohol, engaging in premarital sex, fighting, violating curfew -other discipline problems that often lead to expulsion

or warrant suspension of students from school

ONSET AND CLINICAL COURSE

Adults in whom ADHD was dx in childhood have higher rates of impulsivity, alcohol and drug use, legal troubles and personality disorders.

ETIOLOGY Cause: Unknown Factors: Environmental toxins Prenatal influences

–exposure to alchohol, tobacco, lead, severe malnutrition in early childhood

Heredity -seems to have a genetic link that is likely associated

with abnormalities in Cathecholamin and possibly serotonin metabolism

Damage to brain structures - brain images have suggested a decrease metabolism

in frontal lobes -decreased blood perfusion of the frontal cortex in

children -frontal atrophy in young adults with ADHD history

RISK FACTORS:

Family history Male relatives with antisocial personality disorder or

alcoholism Female relatives with somatization disorder Lower socioeconomic status Male gender Marital or family discord – divorced Neglect Abuse Parental deprivation Low birth rate Various kinds of brain insult

CULTURAL CONSIDERATIONS:

-ADHD is known to occur in various cultures and is more prevalent in Western cultures.

TREATMENT:

-no one treatment has been found effective; ADHD is chronic

-Most effective combines: PHARMACOTHERAPY WITH BEHAVIORAL, PSYCHOSOCIAL AND EDUCATIONAL INTERVENTIONS

Goals of treatment:

Managing symptoms Reduce hyperactivity and impulsivity Increase child's attention so that he can

grow and develop normally

PHARMACOTHERAPY:

Stimulants: Give stimulants during daytime hours to

combat insomnia. Eating a good breakfast with the

morning does and substantial nutritious snacks late in the day and at bedtime will help the child to maintain an adequate dietary intake,

Stimulants:

Most COMMON: Methylphenidate (Ritalin) Amphetamine compound (Adderall)

OTHER STIMULANTS : Dextroamphetamine (Dexedrine) Pemoline (Cylert) –last drug because it

causes liver damage    

Stimulants:

Side effects: insomnia loss of appetite weight loss or failure to gain weight

PHARMACOTHERAPY: Antidepressants

Antidepressants – second choice for treatment

ATOMOXETINE (STRATTERA)

Side effects: In children –nausea, vomiting, tiredness,

decreased appetite, upset stomach In adults – insomnia, dry mouth, urinary

retention, decreased appetite, nausea Vomiting, dizziness, sexual side

effects

STRATEGIES FOR HOME AND SCHOOL

Therapeutic play –often used to understand the child’s thoughts and feelings and to promote communication

Dramatic play – acting out an anxiety-producing situation such as allowing the child to be a doctor or use a stethoscope or other equipment to take care of a patient (a doll)

Play techniques to release energy includes: Pounding pegs Running Working with modeling clay

Creative play – can help children to express themselves

Example: by drawing pictures of themselves, their family and peers

INTERVENTIONS: Ensuring the child’s safety and that of others

Stop unsafe behavior Provide close supervision Give clear directions about acceptable and unacceptable

behavior Improved role performance

Give positive feedback for meeting expectations Manage the environment (quiet place free of distractions)

Simplifying instructions/directions Get child’s full attention Break complex tasks into small steps Allow breaks

Structured daisly routine Establish a daily schedule Minimize changes

Client/family education and support Listen to parent’s feelings and frustrations