“ALL ABOUT ATTENTION DEFICIT

HYPERACTIVITY DISORDER (ADHD)”

-Torregosa, Cyrus Dan A.

Attention deficit hyperactivity

disorder (ADHD or AD/HD or ADD) is
a neurobehavioral developmental disorder
characterized by inattentiveness, hyperactivity, and
impulsiveness. It is primarily characterized by "the co-
existence of attentional problems and hyperactivity,
with each behavior occurring infrequently alone" and
symptoms starting before seven years of age.
ADHD is the most commonly studied and
diagnosed psychiatric disorder in children, affecting
about 3 to 5 percent of children globally and diagnosed
in about 2 to 16 percent of school aged children. It is a chronic disorder with 30 to 50 percent of
those individuals diagnosed in childhood continuing to have symptoms into adulthood.
Adolescents and adults with ADHD tend to develop coping mechanisms to compensate for
some or all of their impairments. 
ADHD is a common disorder, especially in boys, and probably accounts for more child
mental health referrals than any other single disorder (McCracken, 2000a). ADHD affects an
estimated 3% to 5% of all schoolage children. The ratio of boys to girls ranges from 3_1 in
nonclinical settings to 9_1 in clinical settings (McCracken, 2000a). To avoid overdiagnosis of
ADHD, a qualified specialist, such as a pediatric neurologist or a child psychiatrist, must conduct
the evaluation for ADHD. Children who are very active or hard to handle in the classroom can
be diagnosed and treated mistakenly for ADHD. Some of these overly active children may suffer
from psychosocial stressors at home, inadequate parenting, or other psychiatric disorders
(Blackman, 1999).

Signs and Symptoms:

Inattention, hyperactivity, and impulsivity are the key behaviors of ADHD. It is normal
for all children to be inattentive, hyperactive, or impulsive sometimes, but for children with
ADHD, these behaviors are more severe and occur more often. To be diagnosed with the
disorder, a child must have symptoms for 6 or more months and to a degree that is greater
than other children of the same age. (NIH: National Institute of Mental Health)

Children who have symptoms of inattention may:

 Be easily distracted, miss details, forget things, and frequently switch from one activity
to another
 Have difficulty focusing on one thing
 Become bored with a task after only a few minutes, unless they are doing something
enjoyable
 Have difficulty focusing attention on organizing and completing a task or learning
something new
 Have trouble completing or turning in homework assignments, often losing things (e.g.,
pencils, toys, assignments) needed to complete tasks or activities
 Not seem to listen when spoken to
 Daydream, become easily confused, and move slowly
 Have difficulty processing information as quickly and accurately as others
 Struggle to follow instructions.

Children who have symptoms of hyperactivity may:

 Fidget and squirm in their seats
 Talk nonstop
 Dash around, touching or playing with anything and
everything in sight
 Have trouble sitting still during dinner, school, and story
time
 Be constantly in motion
 Have difficulty doing quiet tasks or activities.

 Children who have symptoms of impulsivity may:

 Be very impatient
 Blurt out inappropriate comments, show their emotions
without restraint, and act without regard for
consequences
 Have difficulty waiting for things they want or waiting
their turns in games

ADHD has three subtypes:

1) Predominantly hyperactive-impulsive
 Most symptoms (six or more) are in the hyperactivity-impulsivity categories.
2) Predominantly inattentive
 The majority of symptoms (six or more) are in the inattention category and fewer
than six symptoms of hyperactivity-impulsivity are present, although
hyperactivity-impulsivity may still be present to some degree. Children with this
subtype are less likely to act out or have difficulties getting along with other
children. They may sit quietly, but they are not paying attention to what they are
doing. Therefore, the child may be overlooked, and parents and teachers may
not notice that he or she has ADHD.
3) Combined hyperactive-impulsive and inattentive
 Six or more symptoms of inattention and six or more symptoms of hyperactivity-
impulsivity are present.
 Most children have the combined type of ADHD. Treatments can relieve many of the
disorder's symptoms, but there is no cure. With treatment, most people with ADHD can be
successful in school and lead productive lives. Researchers are developing more effective
treatments and interventions, and using new tools such as brain imaging, to better understand
ADHD and to find more effective ways to treat and prevent it.

Onset and Clinical Course:

ADHD usually is identified and diagnosed when the child
begins preschool or school, although many parents report
problems from a much younger age. As infants, children with
ADHD are often fussy and temperamental and have poor
sleeping patterns. Toddlers may be described as “always on the
go” and “into everything,” at times dismantling toys and cribs.
They dart back and forth, jump and climb on furniture, run
through the house, and cannot tolerate sedentary activities
such as listening to stories. At this point in a child’s
development, it can be difficult for parents to distinguish
normal, active behavior from excessive, hyperactive behavior.
By the time the child starts school, symptoms of ADHD begin to
interfere significantly with behavior and performance (Pary,
Lewis, Matuschka & Lippman, 2002). The child fidgets constantly, is in and out of assigned
seats, and makes excessive noise by tapping or playing with pencils or other objects. Normal
environmental noises, such as someone coughing, distract the child. He or she cannot listen to
directions or complete tasks. The child interrupts and blurts out answers before questions are
completed. Academic performance suffers because the child makes hurried, careless mistakes
in schoolwork, often loses or forgets homework assignments, and fails to follow directions.
Socially, peers may ostracize or even ridicule the child for his or her behavior. Forming positive
peer relationships is difficult because the child cannot play cooperatively or take turns and
constantly interrupts others (APA, 2000). Studies have shown that both teachers and peers
perceive children with ADHD as more aggressive, bossier, and less likable (McCracken, 2000a).
This perception results from the child’s impulsivity, inability to share or take turns,
interruptions, and failure to listen to and follow directions. Thus peers and teachers may
exclude the child from activities and play, may refuse to socialize with the child, or may respond
to the child in a harsh, punitive, or rejecting manner. About two-thirds of children diagnosed
with ADHD continue to have problems in adolescence. Typical impulsive behaviors include
cutting class, getting speeding tickets, failing to maintain interpersonal relationships, and
adopting risk-taking behaviors such as using drugs or alcohol, engaging in sexual promiscuity,
fighting, and violating curfew.
Many adolescents with ADHD have discipline problems serious enough to warrant
suspension or expulsion from high school (McCracken, 2000a). The secondary complications of
ADHD, such as low self esteem and peer rejection, continue to pose serious problems.
Previously it was believed that children outgrew ADHD, but it is now known that ADHD can
persist into adulthood (Wender, 2000). Estimates are that 30% to 50% of children with ADHD
have symptoms that continue into adulthood (Searight, 2000). In one study, adults who had
been treated for hyperactivity 25 years earlier were three to four times more likely than their
brothers to experience nervousness, restlessness, depression, lack of friends, and low
frustration tolerance (Wender, 2000). Adults in whom ADHD was diagnosed in childhood also
have higher rates of impulsivity, alcohol and drug use, legal troubles, and personality disorders.

Etiology:
Although much research is taking place, the definitive causes of ADHD remain unknown.
A combination of factors, such as environmental toxins, prenatal influences, heredity, and
damage to brain structure and functions, is likely responsible (McCracken, 2000a).
Prenatal exposure to alcohol, tobacco, and lead and severe malnutrition in early
childhood increase the likelihood of ADHD. Although the relation between ADHD and dietary
sugar and vitamins has been studied, results have been inconclusive (McCracken,2000a; Pary et
al., 2002). Brain images of people with ADHD have suggested decreased metabolism in the
frontal lobes, which are essential for attention, impulse control, organization, and sustained
goal-directed activity. Studies also have shown decreased blood perfusion of the frontal cortex
in children with ADHD and frontal cortical atrophy in young adults with a history of childhood
ADHD. Another study showed decreased glucose use in the frontal lobes of parents of children
with ADHD who had ADHD themselves (McCracken, 2000a; Pary et al., 2002). Evidence is not
conclusive, but research in these areas seems promising. There seems to be a genetic link for
ADHD that is most likely associated with abnormalities in catecholamine and possibly serotonin
metabolism. Having a first-degree relative with ADHD increases the risk of the disorder by four
to five times that of the general population (McCracken, 2000a). Despite the strong evidence
supporting a genetic contribution, there are also sporadic cases of ADHD with no family history
of ADHD; this furthers the theory of multiple contributing factors. Risk factors for ADHD include
family history of ADHD; male relatives with antisocial personality disorder or alcoholism; female
relatives with somatization disorder; lower socioeconomic status; male gender; marital or
family discord, including divorce, neglect, abuse, or parental deprivation; low birth weight; and
various kinds of brain insult (McCracken,
2000a).

Cultural Considerations:
Crijen, Achenbach & Verhulst (1999) conducted a study of 19,647 children from 12
cultures in which parents used the Child Behavior Checklist to rate problem behaviors in their
children. The total scores for all the categories showed little differences based on culture, but
individual category scores varied as much as 10% based on culture. This finding supports the
consideration that parents from various cultures have a different threshold for tolerating
specific behaviors and that rates of problems differ among cultures. The authors concluded that
an instrument such as the Child Behavior Checklist can be used across cultures to determine
problems (indicated by total score), but the focus of the problems (indicated by individual
category scores) would vary according to the culture of the child and parents. ADHD is known
to occur in various cultures. It is more prevalent in Western cultures, but that may be the result
of different diagnostic practices rather than actual differences in existence (APA, 2000).
 Liceo de Cagayan University
RN Pelaez Boulevard, Kauswagan, CDOC
College of Nursing

TEACHING LEARNING GUIDE

Topic: Attention Deficit Hyperactivity Disorder (ADHD) Date: February 07, 2011
Level of Student: N105, Level III Time: 9:00 am
Venue:Liceo Campus Reporter: Torregosa, Cyrus Dan
C.I.: Mrs. Anecia So, RN, MN

General Objective: At the end of 15 minutes, I will be able to present and discuss effectively the topic about Attention Deficit
Hyperactivity Disorder mainly the definition, prevalence, signs and symptoms, onset and causes; assigned to me, as well as, the
students will gain and increase knowledge from the discussion.

Specific Objective Content Time Teaching Learning Guide Evaluation Reference

Allotment
At the end of 15 Teacher Student Books:
minutes then Psychiatric Mental
students will be able Health Nursing, Second
to: Edition, Lippincott
a) Acquire new -the definition, 5 minutes. Ask Active listening Quiz
Williams by Sheila L.
knowledge of the prevalence and questions and participation.
(Post- Test) Videbeck, Pages 488-492
said condition and statistics and give
verbalize the further
understanding information
Ask questions Internet Sources:
effectively regarding
http://www.nimh.nih.go
the topic.
v/health/publications/att
b) Identify the signs -inattentiveness, 5 minutes.
and symptoms of ention-deficit-
hyperactivity and
the condition hyperactivity-
 impulsivity disorder/complete-
index.shtml

c) Identify the -predisposing and 5 minutes http://www.nlm.nih.gov/

causes of the precipating factors, medlineplus/attentionde
condition onset of the ficithyperactivitydisorder
condition, etiology .html