Transcript PowerPoint Slides - University of Arizona Pediatric Pulmonary Center

Kristen Hedger Archbold, RN, PhD
Assistant Professor
University of Arizona College of Nursing
Faculty, Pediatric Pulmonary Center
Attention Deficit Disorder (ADD)
Attention Deficit Hyperactivity Disorder (ADHD)
Definitions
Prevalence
Treatment
ADD & ADHD Issues for special populations
Asthma
Cystic Fibrosis
Chronic Illness
Sleep Disorders
Attention Deficit Disorder (ADD)
(disclaimer)
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Most commonly referred to as Attention
Deficit/Hyperactivity Disorder, Inattentive
type
Has characteristics of ADHD, but without
motor movement patterns.
For this talk, we will discuss ADHD in a very
general sense that encompasses the full
spectrum of the disorder
Attention Deficit/Hyperactivity
Disorder (ADHD)
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Prevalence estimates 3-7% of school-aged
children (American Psychological
Association, 2000)
Studies report prevalence of 9-12% with a
higher prevalence rate in boys, nearly 2-to-1
Persists into adulthood in majority of cases
ADHD: Societal costs in dollars
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Estimated annual cost per individual: $14,576
(2005 U.S. dollars)
Both adults and children with ADHD have
higher medical costs in general ($1500 per
child, $3000 per adult)
Household incomes in adults with ADHD are
significantly lower regardless of academic
achievement.
(Pelham, Foster & Robb, 2007; Matza, Paramore & Prasad, 2005; Biederman & Faraone, 2006)
ADHD: Social consequences
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Parents of ADHD children
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Increased self-blame
Social isolation
Depression
Marital discord
Employment status of parents is negatively
affected.
(Johnston & Mash, 2001; American Psychological Association, 2000)
ADHD: Definitions
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Diagnostic and Statistical Manual of Mental
Disorders – 4th Edition, Text Revision (DSMIV-TR)
Really is not one universal pattern of
symptoms
Symptoms vary across lifespan
ADHD: cluster of symptoms
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Symptom cluster that MUST be present:
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6 of 9 symptoms of inattention (i.e., does not
listen when spoken to, easily distracted by
extraneous stimuli)
6 of 9 symptoms of Hyperactivity/Impulsivity
(i.e., constantly on the go, leaves seat in
classroom)
Inattentive type, Hyperactive/Impulsive type
and Combined type (majority)
ADHD: diagnosis
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Based on presence of symptoms
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6 months or more
before age 7
Not Otherwise Specified: symptoms don’t fit
entirely into specified categories.
ADHD: Underdiagnosis
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Commonly underdiagnosed
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African American
Low socioeconomic status
Female children
Psychiatric comorbidity
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Depression
Substance Abuse Disorder
Bipolar Disorder, Anxiety
ADHD: Screening tool
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Pediatric Symptom Checklist (Jellinek et al.,
1988)
Use in conjunction with interview by care
provider
Formal diagnosis made by clinical specialists.
ADHD: Preschool aged child
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Difficult to diagnose
Symptoms may differ
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Non-compliance in social settings/school
Dislike by other children
Demanding Behaviors
Core symptoms of motor activity, frustration
intolerance, impulsivity and distractibility are
present.
ADHD: Overall Treatment
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American Academy of Pediatrics (2001)
recommended a thorough plan for treatment
ADHD is a chronic condition
Follow-up in systematic manner
Target outcomes (behavioral, cognitive) are
specified and worked towards.
ADHD: Treatment Nonpharmacologic
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Cognitive Behavior Therapy (CBT) with
ADHD adults, not effective with children
Summer camps, special classrooms,
consistent rewards and punishments
Clinical behavior therapy
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Work with parents, teachers to modify home and
school environments to support the child
10 to 20 sessions of about 90 minutes each
ADHD: Clinical behavioral therapy
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ADHD education
Attend carefully to child’s behavior and
respond consistently, appropriately
Daily school report card
Token reward system
Effective use of time-outs
(Plizka, 2007; Smith et al., 2006)
ADHD: Pharmacological treatment
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Stimulant medications
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Ritalin
Methamphetamine
Adderal (only one approved for age 3 and older)
Non-stimulant medication
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Atamoxetine
Side effects: decreased appetite, headache,
insomnia
ADHD: Pharmacological treatment
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Tricyclic antidepressants (TCA)
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Buproprion
Alpha Agonists
Combination therapy, complex treatment
algorithm
ADHD: Co-morbidities
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Can co-exist with any medical condition
Stigmas associated with medication use
(African American) and mental illness
(Hispanic) have been reported, therapies must
be designed with cultural appropriateness.
ADHD: Individualized Education
Program (IEP)
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Created in 2006
Parents, school staff work together to develop
a plan for each ADHD patient
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Focus on goals to be achieved
Accommodations necessary in classroom
How progress will be measured
ADHD: Section 504
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1973 Rehabilitation Act
A plan is developed
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Assistive technology
Extra time for completion of assignments
Parents must be educated on which plan is better for
their child, criteria may vary state-to state
Plans MUST be individualized for each child’s
needs.