PEDIATRICS ADHD P a R T I
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PEDIATRICS ADHD P a r t I Jassin M. Jouria, MD Dr. Jassin M. Jouria is a medical doctor, professor of academic medicine, and medical author. He graduated from Ross University School of Medicine and has completed his clinical clerkship training in various teaching hospitals throughout New York, including King’s County Hospital Center and Brookdale Medical Center, among others. Dr. Jouria has passed all USMLE medical board exams, and has served as a test prep tutor and instructor for Kaplan. He has developed several medical courses and curricula for a variety of educational institutions. Dr. Jouria has also served on multiple levels in the academic field including faculty member and Department Chair. Dr. Jouria continues to serves as a Subject Matter Expert for several continuing education organizations covering multiple basic medical sciences. He has also developed several continuing medical education courses covering various topics in clinical medicine. Recently, Dr. Jouria has been contracted by the University of Miami/Jackson Memorial Hospital’s Department of Surgery to develop an e-module training series for trauma patient management. Dr. Jouria is currently authoring an academic textbook on Human Anatomy & Physiology. ABSTRACT Attention Deficit/Hyperactivity Disorder (ADHD) is a diagnosis that tends to cause a lot of fear and confusion in parents and caregivers, but receiving the proper information in a timely manner from medical professionals can help alleviate many of those feelings. ADHD is a chronic disorder that includes a combination of symptoms, including hyperactivity, impulsivity, and difficulty sustaining attention. Millions of children struggle with ADHD, but there is plenty of cause for hope. Symptoms of ADHD frequently ease as the patient reaches adulthood, and there are good medical and behavioral treatment strategies available. It is important to carefully screen patients according to current standards before making an ADHD diagnosis. In order to avoid overdiagnosing, a child shouldn't receive a diagnosis of ADHD unless the core symptoms of ADHD start early in life and create significant problems at home and at school on an ongoing basis. Nursece4Less.com Nursece4Less.com Nursece4Less.com Nursece4Less.com 1 Policy Statement This activity has been planned and implemented in accordance with the policies of NurseCe4Less.com and the continuing nursing education requirements of the American Nurses Credentialing Center's Commission on Accreditation for registered nurses. It is the policy of NurseCe4Less.com to ensure objectivity, transparency, and best practice in clinical education for all continuing nursing education (CNE) activities. Continuing Education Credit Designation This educational activity is credited for 3 hours. Nurses may only claim credit commensurate with the credit awarded for completion of this course activity. Statement of Learning Need Nurses, depending on their role and training, may or may not have primary responsibility to diagnose ADHD; however, they contribute to the formulation of a diagnosis and plan of care through observation and interaction with children, parents and teachers and rely upon expert knowledge to use the right screening tool and methods identify behaviors and social challenges associated with ADHD. Course Purpose To prepare nurses to have knowledge of pediatric ADHD, methods of diagnosing associated disorders and behavioral outcomes, and to participate in interprofessional collaborative treatment that involves the patient and their family. Nursece4Less.com Nursece4Less.com Nursece4Less.com Nursece4Less.com 2 Target Audience Advanced Practice Registered Nurses and Registered Nurses (Interdisciplinary Health Team Members, including Vocational Nurses and Medical Assistants may obtain a Certificate of Completion) Course Author & Planning Team Conflict of Interest Disclosures Jassin M. Jouria, MD, William S. Cook, PhD, Douglas Lawrence, MA, Susan DePasquale, MSN, FPMHNP-BC - all have no disclosures Acknowledgement of Commercial Support There is no commercial support for this course. Please take time to complete a self-assessment of knowledge, on page 4, sample questions before reading the article. Opportunity to complete a self-assessment of knowledge learned will be provided at the end of the course. Nursece4Less.com Nursece4Less.com Nursece4Less.com Nursece4Less.com 3 1) _________________ are the primary neurotransmitters that mediate frontal-lobe function. a. Amino acids b. Catecholamines c. Gaba peptides d. Acetlycholine derivites 2) The predominantly hyperactive/impulsive type of ADHD is usually characterized by high energy and constant movement. The classic manifestation(s) of this type of ADHD is/are _____________. a. Inattentiveness or lack of attention b. Disorganization c. Forgetfulness d. All of the above 3) Children with predominantly ___________ type of ADHD face barriers when trying to form social relationships with other children due to their tendency to be easily angered and provoked. a. Inattentive b. Impulsivity c. Autistic d. Hyperactivity 4) A comprehensive neurologic examination needs to be performed in children with ADHD to rule out the possibility of neurodegenerative disorders such as _______________. a. Alzheimer’s Disease b. Parksinson’s Disease c. Adrenal leukodystrophy d. Mad Cow disease 5) The formal diagnosis of ADHD in children, adolescents, and adults usually occur in __________________. a. School b. Primary care settings c. Secondary care settings d. Home Nursece4Less.com Nursece4Less.com Nursece4Less.com Nursece4Less.com 4 Introduction According to the National Institute of Mental Health, attention deficit hyperkinetic disorder or ADHD is a relatively common brain disorder that is often diagnosed at childhood and continues to adolescence and adulthood.1 Children with ADHD sometimes exhibit uncontrollable behavioral symptoms that are frequent and severe which interferes with their ability to cope at school and live normal lives outside of it. Pediatric ADHD causes hyperactivity and impulsivity and/or inattention in affected children. Many children experience these behavioral issues at some time during their childhood. However, in children with ADHD, these behavioral problems persist over a long period of time. To be diagnosed with ADHD, these behaviors must continue for at least 6 months and be present in two environments such as home and school. Clinicians should be able to diagnose this disorder early on to evaluate the patient and provide for all the necessary pharmacotherapeutic and behavioral interventions that will minimize symptoms and restore social and academic functions. This course specifically discusses ADHD in children or pediatric ADHD. An effective management of ADHD requires a multidisciplinary team approach that includes the patient, the family, the school, and the clinician. This course discusses in detail the management and diagnostic approaches that every healthcare professional in contact with an ADHD patient should be familiar with and understand. Nursece4Less.com Nursece4Less.com Nursece4Less.com Nursece4Less.com 5 History The modern concept of attention deficit hyperactivity disorder (ADHD) as defined by the Diagnostic and Statistical Manual IV (DSM-IV) is fairly new. However, its hallmark symptoms of over activity, inattentiveness, and impulsiveness in children have been observed and recorded by physicians as early as the 19th century. A notable example is Sir Alexander Crichton who, in 1798, wrote a book entitled “On Attention and its Diseases”. In this book, he defines ADHD as; “when any object of external sense, or of thought, occupies the mind in such a degree that a person does not receive a clear perception from any other one, he is said to attend to it”. Crichton further records his observations of the progression of the disorder, writing, ”when born with a person it becomes evident at a very early period of life, and has a very bad effect, inasmuch as it renders him incapable of attending with constancy to any one object of education. But it seldom is in so great a degree as totally to impede all instruction; and what is very fortunate, it is generally diminished with age”.2 The idea brought forth another idea i.e. that ADHD is a pediatric disorder which patients outgrow as they grow older. This idea of growing out of ADHD was prevalent up until the late 1990s. It was only fairly recently that scientific studies have shown otherwise; that in fact, approximately half of affected children diagnosed with ADHD continue to exhibit the symptoms well into their adulthood.3,4 Another physician, Heinrich Hoffman, published a series of illustrated children’s books depicting characters with symptoms of ADHD. One of the most notable ones was Johnny Look-in-the-air, who was depicted as a boy who exhibited telltale symptoms of inattention. In the book, Johnny was always “looking at the sky and the clouds that floated by”, a symptom that Nursece4Less.com Nursece4Less.com Nursece4Less.com Nursece4Less.com 6 the American Psychiatric Association attributes to frequent distraction by an extraneous stimuli.5 The scientific concept of ADHD started with the publication of Goulstonian Lectures by the British pediatrician, Sir Frederic Still. In these lectures, he describes symptoms of abnormal defect of moral control in children with mental retardation, which are commonly seen today in patients diagnosed with ADHD. Some of these symptoms are passionateness, spitefulness, jealousy, lawlessness, dishonesty, and destructiveness.