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9 hours agoTiffany Dyson RE: Parent Guide Discussion – Week 3- ADHDCOLLAPSE
ADHD Parent Guide
Attention-deficit/hyperactivity disorder (ADHD) is defined as a chronic neurological disorder characterized by a persistent pattern of inattention and/or hyperactivity/impulsivity. In 2016, it is estimated that 6.1 million or 9.4% of children had a diagnosis of ADHD (Centers for Disease Control and Prevention, n.d.). Adiagnosis of ADHD can be both confusing and welcomed. Confusing because the details of the diagnosis are unknown but welcomed because the parents and child finally have a why for the childs difficulties.This parent guide will discuss the pathophysiolology, diagnosing, signs/symptoms, treatment options, and other aspects involved in an ADHD diagnosis.
Pathophysiology
Manyresearch studiessuggest ADHD may be caused by interactions between genes and environmental or non-genetic factors. Many cases of ADHD have a genetic origin. A child is 50% more likely to have ADHD if their parent was diagnosed with the condition and 25% of the children with ADHD have parents who have met the criteria for a diagnosis of ADHD.Other factors that can contribute to ADHD is substance use, low birth weight, brain injuries and exposure to some environmental toxins.
ADHD is a result ofneurotransmitter disease dysfunction, that effect dopamine andnorepinephrine. Dopamine has a role in a person’s ability to learn and reinforcing trained response to various situations. Dopamine also plays and important role in “working memory”(Attention-deficit Hyperactivity Disorder, 2004).Norepinephrineeffects a person’s alertness and attention.Norepinephrineis activated by novel and important stimuli and are quiescent during sleep.
Environmental factors of ADHD is a result of a toxin such as lead or othernuero-toxic substances that mayresultin delayed development of the child’s brain before, during or birth. Substance abuse is a very common cause ofpre- and perinatal factors that may result in ADHD.Exposure of the fetus to alcohol is associated with a reduction in the volume of theprefrontaland temporal cortices, the brain areas involved in regulation of attention and control ofimpulsivity.(Attention-deficit Hyperactivity Disorder, 2004)
Diagnosing ADHD
While there is no single test to diagnosis ADHD, there are ways to obtain an accurate diagnosis.
Who diagnosis ADHD?
There are many health care professionals who are qualified to diagnose ADHD. These professionals include but are not limited to psychiatrist, psychiatric mental health nurse practitioner (PMHNP), licensed master social worker (LMSW), licensed professional counselor (LPC), neurologist, pediatricians, and primary care physicians. If there is a concern that a child/adolescent may have ADHD, one of these professionals should be consulted.
Who Can Provide Information?
Information should be obtained from multiple sources who are able to observe the child/adolescent in different environments (Children and Adults with Attention-Deficit/Hyperactivity Disorder, n.d.). This creates an ability for many aspects of the child/adolescents life to be assessed as symptoms may or may not be present or the severity may differ depending on the situation. Examples of potential sources of information can include the child/adolescent, parents, family members, teachers, and/or child-care providers.
Assessment
A comprehensive assessment is an evaluation of the child/adolescents presenting behaviors related to physical, social, environmental, cognitive, emotional, genetic, and educational aspects of life that may be affected by the behaviors(Johns Hopkins Medicine, n.d.).There are multiple parts of a comprehensive assessment. First, the psychiatric interview will entail gathering information concerning specific behaviors and symptoms. It will also include the effects of the behavior/symptom on the child/adolescents performance in the home, school, and community environment. Second, personal and family history will be obtained related to behavioral, emotional, and developmental disorders to determine the possibility of genetic patterns/conditions. Third, a complete medical history including past and present illnesses/conditions as well as treatments will be obtained to assess the potential effects on behavior. Fourth, lab test will be obtained to determine/rule-out medical conditions. Fifth, tools such as questionnaires, checklist, and rating scales will be used to assist in identifying symptoms of ADHD.
Differential Diagnosing
Differential diagnosing is used to differentiate between multiple conditions that present with similar signs and/or symptoms. ADHD differential diagnosing includes differentiating between age appropriate behaviors in active children, intellectual disability, oppositional behavior, and symptoms better accounted for by another mental disorder such as anxiety, dissociative disorder, and personality disorders (American Psychiatric Association, 2013).
Diagnostic Criteria
Diagnostic criteria are defined as a set of signs and symptoms used to identify and determine a diagnosis. The three subtypes of ADHD are as follows: ADHD, Predominantly Inattentive Type; ADHD, Predominantly Hyperactive-Impulse Type; and ADHD, Combined Type.The following are the diagnostic criteria for each subtype. Persistent symptoms for 6 months or greater in 2 or more environments. The symptoms must be developmentally inappropriate and disrupt social, academic, and/or occupational functioning. A minimum of 6 symptoms must be present in children 16 years of age and younger for a diagnosis of ADHD, Inattentive Type or ADHD, Hyperactive/ImpulsiveType. However, enough symptoms of both type must be present for a diagnosis of ADHD, Combined Type.
Signs andSymptoms
ADHD, Inattentive Type
Inattentiveness:(Symptoms and Diagnosis of Adhd | Cdc, 2020)
Doesn’t listen when spoken to directly
Forgetful in daily activities
Difficulty organizing task and activities
Easily distracted
Reluctant to perform activities that require metal efforts for long periods of time
Does not pay attention to details
Makes careless mistakes
Often loses things
ADHD, Hyperactive/Impulsive Type
Hyperactive and impulsivity:(Symptoms and Diagnosis of Adhd | Cdc, 2020)
Often fidgets with or taps hands or feet, or squirms in seat
Often unable to play or take part in leisure activities quietly
Often talks excessively
Often has trouble waiting their turn
Often has trouble waiting their turn
Often leaves seatwhen expected to remain seated
Often exhibits “on the go” behavior
ADHD, Combined Type
A combination of ADHD, Inattentive Type & ADHD, Hyperactive/Impulsive Type
Treatment
While there is no cure for ADHD, symptom management can be obtained. Treatment of ADHD typically involves medication, psychotherapy, or a combination of the two.
Medication
There are many types of medications that can assist in effectively managing the symptoms of ADHD. To begin, stimulant medication treats moderate to severe ADHD and assist in controlling thoughts while ignoring distractions. Examples are Adderall, Vyvanse, and Ritalin. Next, non-stimulant medication are used when stimulant medications prove ineffective or yield unpleasant side effects and assist with concentration and impulse control. Examples are Strattera, Intuniv, and Clonidine.
Psychotherapy
Psychotherapy is a treatment technique used to identify and change emotions, thoughts, and behaviors that may be inappropriate. Psychotherapy to treat ADHD can improve time management/organization skills, reduce impulsive behavior, improve problem solving skills, and identify/support the use of effective coping skills. An example of psychotherapy is cognitive behavioral therapy (CBT). CBT is a psychotherapy intervention that focuses on challenging and improving behavior and negative thought processes.
My Child Has ADHD: Now What?
Do not blame yourself! While there is a genetic component to ADHD (CHADD.org, n.d.), it is important to remember that ADHD does not develop from poor parenting or not loving your child enough. To be sure, the home environment can play a role in how your child will cope with ADHD, it is not a cause. Also, educate yourself on ADHD. It is not uncommon for parents to find that they have likely had ADHD all their lives, as well, but never had a name for their struggles (Miller, 2018).
Concrete Steps to Help Your Child
According to the CDC (2020), parental training in behavior management, behavioral therapy for the child, and behavioral interventions in the classroom are good places to start outside of medication. Some tips that the CDC (2020) recommends for parents of children with ADHD recommend include:
Limit choices
Be clear and specific when communicating with your child
Help your child plan
Use goals and praise/reward your child
Create a routine
Additionally, some parents find it helpful to join support groups or seek professional help for themselves as a new ADHD diagnosis can cause feelings of frustration and even depression (CHADD.org, n.d.). These feelings, while normal, can make it more difficult to help your child and seeking support can benefit the entire family.
Conclusion
Receiving a diagnosis of ADHD for your child can be overwhelming. Taking the time to educate yourself on the pathophysiology, signs and symptoms, diagnostic criteria, and treatment of ADHD can help to alleviate some of the natural anxiety/concern that occurs. Additionally, recognizing the ways a parent can directly support their child with ADHD can help the new diagnosis feel less scary and give the parent (and patient!) some needed tools that can help the patient function better and with less difficulty. While a new diagnosis of any kind can seem intimidating, using the resources available, including your PMH-NP, can help the family adapt to the new information more smoothly.
References
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: Author.
Attention-deficit hyperactivity disorder. (2004). Medscape. Retrieved December 31, 2019, fromhttps://www.medscape.com/viewarticle/495640_3
Centers for Disease Control and Prevention. (n.d.). Attention-Deficit/Hyperactivity Disorder (ADHD). Retrieved fromhttps://www.cdc.gov/ncbddd/adhd/data.html
Children and Adults with Attention-Deficit/Hyperactivity Disorder. (n.d.). Comprehensive Assessment. Retrieved fromhttps://chadd.org/for-parents/comprehensive-assessment/
Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD). (n.d.). ParentingA Child with ADHD. Retrieved fromhttps://chadd.org/for-parents/overview/
Johns Hopkins Medicine. (n.d.).Comprehensive Psychiatric Evaluation. Retrieved fromhttps://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/comprehensive-psychiatric-evaluatio
Miller, G. (2018 February 16). Parents Are Realizing They Have ADHD Once Their Kids AreDiagnosed. Retrieved from https://www.healthline.com/health-news/parents-realizing-they-have-adhd-once-kids-are-diagnosed#1
Symptoms and diagnosis of adhd | cdc. (2020, September 3). Centers for Disease Control and Prevention.https://www.cdc.gov/ncbddd/adhd/diagnosis.html
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