ADD & ADHD: Current Issues in Pediatric Health Kristen Hedger Archbold, RN, PhD Assistant Professor University of Arizona College of Nursing Faculty, Pediatric Pulmonary Center
Jan 11, 2016
ADD & ADHD: Current Issues in Pediatric Health
Kristen Hedger Archbold, RN, PhDAssistant ProfessorUniversity of Arizona College of NursingFaculty, 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) 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) 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 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 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)
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
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)
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.
ADHD: Underdiagnosis Commonly underdiagnosed
African American Low socioeconomic status Female children
Psychiatric comorbidity Depression Substance Abuse Disorder Bipolar Disorder, Anxiety
ADHD: Screening tool 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 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.
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.
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
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)
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
ADHD: Pharmacological treatment Tricyclic antidepressants (TCA)
Buproprion Alpha Agonists Combination therapy, complex treatment
algorithm
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.
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
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.