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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.). A diagnosis 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 child’s difficulties.  This parent guide will discuss the pathophysiolology, diagnosing, signs/symptoms, treatment options, and other aspects involved in an ADHD diagnosis. 

Pathophysiology   

Many research studies suggest 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 of neurotransmitter disease dysfunction, that effect dopamine and norepinephrine. 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). Norepinephrine effects a person’s alertness and attention. Norepinephrine is 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 other nuero-toxic substances that may result in delayed development of the child’s brain before, during or birth. Substance abuse is a very common cause of pre- and perinatal factors that may result in ADHD. Exposure of the fetus to alcohol is associated with a reduction in the volume of the prefrontal and temporal cortices, the brain areas involved in regulation of attention and control of impulsivity. (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/adolescent’s 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/adolescent’s 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/adolescent’s 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/Impulsive Type. However, enough symptoms of both type must be present for a diagnosis of ADHD, Combined Type.

Signs and Symptoms

ADHD, Inattentive Type

1. 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

1. 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 seat when 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, from https://www.medscape.com/viewarticle/495640_3

Centers for Disease Control and Prevention. (n.d.). Attention-Deficit/Hyperactivity Disorder (ADHD). Retrieved from https://www.cdc.gov/ncbddd/adhd/data.html

Children and Adults with Attention-Deficit/Hyperactivity Disorder. (n.d.). Comprehensive Assessment. Retrieved from https://chadd.org/for-parents/comprehensive-assessment/

Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD). (n.d.). Parenting A Child with ADHD. Retrieved from https://chadd.org/for-parents/overview/

Johns Hopkins Medicine. (n.d.). Comprehensive Psychiatric Evaluation. Retrieved from https://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 Are Diagnosed. 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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