# Attention Deficit Hyperactivity Disorder --- **Attention deficit hyperactivity disorder** or **ADHD** is a particular challenges for sustained attention, and especially children have too high energy • Impuls:vily/hyperactivity Inattention • Combined presentation • Often recognized once the child is in school • More common in boys than girls • Overall prevalence of school aged children 10,.4% • Without treatment higher risk for substance use Risky behavior, difficulty wilh relationships • Comorbidity - depression (30%) anxiety (20%) • Increased risk for Injury - suboptimal motor performance; impulsiveness, attention ## Risk Factors/Cause ## Signs & Symptoms The signs and symptoms of attention deficit hyperactivity disorder ## Complications ## Diagnostic Tests • No single test • 6 symptoms 6 months for 16 years and younger ## Treatment Treatment for attention deficit hyperactivity disorder consists of Treatment Atomoxetine ([[SNRI]]) S/E• insomnia, decreased appelile• NON stimulant Methylphenidate (monitor weight qaifl! HR/BP! MA) Ritalin STIMULANT monitor height and weight appititie, headaches can cause psychosis controlled CBI behavioral therapy, family therapy Treatment for ADHD consists of Methylphenidate - stimulant. scheduled medication side effects - high abuse potential - rebound effect - weight loss - decreased appetite - blood pressure! (monitor for increase) - sometimes drs will have them take a "drug holiday" but that's going away Atomoxetine - nonstimulant - we can use them together with stmulants ## Nursing Considerations it is a stimulant. it doesn't work differently for someone with ADHD, their heartrate is elevated, all that. But they need that help to focus. Stimulants are also cognitive enhancers, and increase the focus. It's the same reason you pour yourself a cup of coffee before you sit down to study. There's a reason there's a black market for Ritalin in college, it feels good and you can get more done. There's a school of thought that this is developmental in nature and they can grow out of it, or low-stimulating environment. Like you might see a super plain and bare classroom, but someone with ADHD is the one who can't study unless there's the radio playing and a movie on. There is a school of thought that [[welbutrin]] can help, and also that some blood pressure med can help. But for the most part, it's the meth approach. And in appropriate doses it can improve function. Humans in general are at a high risk of a [[stimulant use disorder]]. And *especially* people with ADHD. And then you get into a conundrum, where you have a young person, who has ADHD, who has a bunch of problems with functioning, and we're *giving* them a drug of abuse. And they may be addicted to drugs that we started giving them in second grade. The difference between medicine and poison is dose. The benefits can outweigh the risks. The answer is as clear as mud, but just because someone develops a stimulant use disorder and we gave them ritialin in second grade...well yes, they're at high risk for a stimulant disorder anyway. *Untreated* ADHD is a big risk factor for stimulant use disorder.o ## Nursing Considerations Other considerations Weight (on vs off medications) Nutrition (all natural - chemical free) Insomnia • sleep diary • Set clear limits - clear expectations, eye contact • Predictable environments, homework in quiet place sometime the person doesn't mind the distractability, but the people around them/family/partner doesn't want them to be like that ___