Content Reviewers:Lisa Miklush, PhD, RNC, CNS, Antonella Melani, MD, Jodi Berndt, PhD, RN, CCRN-K, PCCN-K, CNE, CHSE, Jannah Amiel, MS, BSN, RN, Gabrielle Proper, RN, BScN, MN
Paul Truslow is a 11-year-old boy who is brought to the pediatrician by his mother, Ms. Truslow. Ms. Truslow is concerned because Paul hasn’t been performing well in school, stating that he doesn’t always turn in his homework assignments, and when he does, the assignments are often incomplete. At home, Ms. Truslow says that Paul forgets to do daily tasks like brush his teeth, make his bed, and take out the garbage. Ms. Truslow and his teachers are concerned about Paul, and are worried about his grades. The pediatrician is evaluating Paul for ADHD.
Attention-deficit hyperactivity disorder, or ADHD for short, refers to a range of behaviors characterized by inattention, as well as hyperactivity and impulsivity, and is the most common mental health disorder affecting pediatric clients in the US, with males being affected more frequently than females. However this may be due to bias in referral or diagnosis.
The exact cause of ADHD is still not well understood, but it seems to be associated with the activity of dopaminergic and noradrenergic neurons within the brain. These neurons produce and store in small vesicles the neurotransmitters dopamine and norepinephrine, respectively. Dopamine binds to dopamine receptors and stimulates cognitive functions, motivation, and awakeness. On the other hand, norepinephrine binds to norepinephrine receptors, subsequently boosting alertness and focus. Now, in clients with ADHD, it’s thought that there are lower amounts of these two neurotransmitters in the brain, although the reason why is still unknown.
Some risk factors may reach back to a child’s development as a fetus during pregnancy and they include exposure to alcohol, tobacco, and cocaine; as well as premature birth, and a birth weight lower than 1,500 grams. On the other hand, early childhood risk factors include exposure to lead, iron deficiency, head trauma, obstructive sleep apnea, and certain infectious diseases, such as chickenpox and measles. Finally, psychosocial risk factors include domestic violence, conflicts, neglect, and emotional abuse.
Now, symptoms of ADHD typically appear prior to the age of 12 years, are out of proportion for the client’s developmental level, last for at least six months, and can persist till adulthood. The most characteristic symptoms of ADHD are inattention, as well as hyperactivity and impulsivity.
Inattention tends to show when children are involved in tasks that require focus and sustained mental effort. These children struggle to sustain attention, follow instructions, and are easily distracted by extraneous stimuli, like music. As a result, they often make careless mistakes or fail to finish tasks such as chores and homework. On the other hand, clients with hyperactivity and impulsivity often struggle to sit still and may fidget, tap their feet or hands, or squirm in their seats. In addition, they often spontaneously get up or run around in circumstances where remaining seated is expected, for example in a classroom. Finally, they tend to talk excessively and interrupt others, and have difficulty waiting their turn.
Over time, ADHD can have some long-term consequences, such as impaired school performance and falling behind in their academic work. Ultimately, this can lead to a decreased level of education, and the development of mental health conditions like anxiety, depression, or sleep disorders. In addition, ADHD can affect relationships with their parents, siblings, teachers, and peers.
Treatment of ADHD is often challenging, and mainly involves behavioral therapy, which focuses on teaching the child better time management and organizational skills, as well as how to better cope with stress and anxiety. In addition, parent-child behavioral therapy can help improve parent-child relationships through enhanced parenting techniques, and social skills training can help tackle deficits in social skills with peers.
Other things that can improve the child's quality of life include maintaining a daily schedule, keeping distractions to a minimum, and setting small and reachable tasks. Additionally, any coexisting mental health conditions should be addressed accordingly. Finally, some children may benefit from stimulant medications like methylphenidate and dextroamphetamine.