kristen hedger archbold, rn, phd assistant professor university of arizona college of nursing...
TRANSCRIPT
![Page 1: Kristen Hedger Archbold, RN, PhD Assistant Professor University of Arizona College of Nursing Faculty, Pediatric Pulmonary Center](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e585503460f94b518f4/html5/thumbnails/1.jpg)
ADD & ADHD: Current Issues in Pediatric Health
Kristen Hedger Archbold, RN, PhDAssistant ProfessorUniversity of Arizona College of NursingFaculty, Pediatric Pulmonary Center
![Page 2: Kristen Hedger Archbold, RN, PhD Assistant Professor University of Arizona College of Nursing Faculty, Pediatric Pulmonary Center](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e585503460f94b518f4/html5/thumbnails/2.jpg)
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
![Page 3: Kristen Hedger Archbold, RN, PhD Assistant Professor University of Arizona College of Nursing Faculty, Pediatric Pulmonary Center](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e585503460f94b518f4/html5/thumbnails/3.jpg)
Attention Deficit Disorder (ADD)(disclaimer) 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
![Page 4: Kristen Hedger Archbold, RN, PhD Assistant Professor University of Arizona College of Nursing Faculty, Pediatric Pulmonary Center](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e585503460f94b518f4/html5/thumbnails/4.jpg)
Attention Deficit/Hyperactivity Disorder (ADHD) 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
![Page 5: Kristen Hedger Archbold, RN, PhD Assistant Professor University of Arizona College of Nursing Faculty, Pediatric Pulmonary Center](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e585503460f94b518f4/html5/thumbnails/5.jpg)
ADHD: Societal costs in dollars 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)
![Page 6: Kristen Hedger Archbold, RN, PhD Assistant Professor University of Arizona College of Nursing Faculty, Pediatric Pulmonary Center](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e585503460f94b518f4/html5/thumbnails/6.jpg)
ADHD: Social consequences Parents of ADHD children
Increased self-blame Social isolation Depression Marital discord
Employment status of parents is negatively affected.
(Johnston & Mash, 2001; American Psychological Association, 2000)
![Page 7: Kristen Hedger Archbold, RN, PhD Assistant Professor University of Arizona College of Nursing Faculty, Pediatric Pulmonary Center](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e585503460f94b518f4/html5/thumbnails/7.jpg)
ADHD: Definitions Diagnostic and Statistical Manual of Mental
Disorders – 4th Edition, Text Revision (DSM-IV-TR)
Really is not one universal pattern of symptoms
Symptoms vary across lifespan
![Page 8: Kristen Hedger Archbold, RN, PhD Assistant Professor University of Arizona College of Nursing Faculty, Pediatric Pulmonary Center](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e585503460f94b518f4/html5/thumbnails/8.jpg)
ADHD: cluster of symptoms Symptom cluster that MUST be present:
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)
![Page 9: Kristen Hedger Archbold, RN, PhD Assistant Professor University of Arizona College of Nursing Faculty, Pediatric Pulmonary Center](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e585503460f94b518f4/html5/thumbnails/9.jpg)
ADHD: diagnosis Based on presence of symptoms
6 months or more before age 7
Not Otherwise Specified: symptoms don’t fit entirely into specified categories.
![Page 10: Kristen Hedger Archbold, RN, PhD Assistant Professor University of Arizona College of Nursing Faculty, Pediatric Pulmonary Center](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e585503460f94b518f4/html5/thumbnails/10.jpg)
ADHD: Underdiagnosis Commonly underdiagnosed
African American Low socioeconomic status Female children
Psychiatric comorbidity Depression Substance Abuse Disorder Bipolar Disorder, Anxiety
![Page 11: Kristen Hedger Archbold, RN, PhD Assistant Professor University of Arizona College of Nursing Faculty, Pediatric Pulmonary Center](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e585503460f94b518f4/html5/thumbnails/11.jpg)
ADHD: Screening tool Pediatric Symptom Checklist (Jellinek et al.,
1988) Use in conjunction with interview by care
provider Formal diagnosis made by clinical specialists.
![Page 12: Kristen Hedger Archbold, RN, PhD Assistant Professor University of Arizona College of Nursing Faculty, Pediatric Pulmonary Center](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e585503460f94b518f4/html5/thumbnails/12.jpg)
ADHD: Preschool aged child Difficult to diagnose Symptoms may differ
Non-compliance in social settings/school Dislike by other children Demanding Behaviors
Core symptoms of motor activity, frustration intolerance, impulsivity and distractibility are present.
![Page 13: Kristen Hedger Archbold, RN, PhD Assistant Professor University of Arizona College of Nursing Faculty, Pediatric Pulmonary Center](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e585503460f94b518f4/html5/thumbnails/13.jpg)
ADHD: Overall Treatment 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.
![Page 14: Kristen Hedger Archbold, RN, PhD Assistant Professor University of Arizona College of Nursing Faculty, Pediatric Pulmonary Center](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e585503460f94b518f4/html5/thumbnails/14.jpg)
ADHD: Treatment Nonpharmacologic Cognitive Behavior Therapy (CBT) with
ADHD adults, not effective with children Summer camps, special classrooms,
consistent rewards and punishments Clinical behavior therapy
Work with parents, teachers to modify home and school environments to support the child
10 to 20 sessions of about 90 minutes each
![Page 15: Kristen Hedger Archbold, RN, PhD Assistant Professor University of Arizona College of Nursing Faculty, Pediatric Pulmonary Center](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e585503460f94b518f4/html5/thumbnails/15.jpg)
ADHD: Clinical behavioral therapy 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)
![Page 16: Kristen Hedger Archbold, RN, PhD Assistant Professor University of Arizona College of Nursing Faculty, Pediatric Pulmonary Center](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e585503460f94b518f4/html5/thumbnails/16.jpg)
ADHD: Pharmacological treatment Stimulant medications
Ritalin Methamphetamine Adderal (only one approved for age 3 and older)
Non-stimulant medication Atamoxetine
Side effects: decreased appetite, headache, insomnia
![Page 17: Kristen Hedger Archbold, RN, PhD Assistant Professor University of Arizona College of Nursing Faculty, Pediatric Pulmonary Center](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e585503460f94b518f4/html5/thumbnails/17.jpg)
ADHD: Pharmacological treatment Tricyclic antidepressants (TCA)
Buproprion Alpha Agonists Combination therapy, complex treatment
algorithm
![Page 18: Kristen Hedger Archbold, RN, PhD Assistant Professor University of Arizona College of Nursing Faculty, Pediatric Pulmonary Center](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e585503460f94b518f4/html5/thumbnails/18.jpg)
ADHD: Co-morbidities 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.
![Page 19: Kristen Hedger Archbold, RN, PhD Assistant Professor University of Arizona College of Nursing Faculty, Pediatric Pulmonary Center](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e585503460f94b518f4/html5/thumbnails/19.jpg)
ADHD: Individualized Education Program (IEP) Created in 2006 Parents, school staff work together to develop
a plan for each ADHD patient Focus on goals to be achieved Accommodations necessary in classroom How progress will be measured
![Page 20: Kristen Hedger Archbold, RN, PhD Assistant Professor University of Arizona College of Nursing Faculty, Pediatric Pulmonary Center](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e585503460f94b518f4/html5/thumbnails/20.jpg)
ADHD: Section 504 1973 Rehabilitation Act A plan is developed
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.