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ADHD for School Nurses PowerPoint Presentation

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Description : Check out this medical presentation on Pediatrics, which is titled "ADHD for School Nurses", to know about ADHD as a school nurse.

Tags : Pediatrics, ADHD, School Nurses

Published on : Aug 03, 2021 | Views : 1800 | Downloads : 3

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Slide 1-

ADHD for School Nurses Jackie Tomberlin, MS, RN
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ADHD is the most common childhood-onset psychological disorder, estimated to affect 5-7% of children world-wide. It has been shown to have significant impact on multiple domains of quality of life in children and adolescents. Why does ADHD matter?
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Self esteem—negative beliefs about self Leads to maladaptive coping strategies (avoidance, procrastination, acting out) Social function—poor peer relationships, family conflict, risky early sexual behavior, bullying, substance abuse Why does ADHD matter?
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Hyperactive, distractible, impulsive Underachieving in school Disruptive and often in trouble Socially unsuccessful Can concentrate on things they find interesting or fun Cannot concentrate on tedious or complex Do you know this child?
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Boys 4X more likely to be diagnosed than girls Found in every culture Lower grades, more delinquency, arrests, aggression, injuries, hospitalizations, truancy, failed jobs and relationships TRENDS
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Unknown, but strong suggestion of a faulty dopamine transporter 76% risk appears familial (primary relatives have a 5-7X higher risk of having ADHD) Head injury, lead or other environmental exposure Maternal smoking, ETOH, prematurity thought to contribute CAUSES
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Pre-frontal cortex inhibits and directs executive function: planning, prioritization, organization, impulse control Pre-frontal cortex development in children with ADHD is 3 years delayed on average ADHD is a developmental delay in impulse control, concentration, organization Pre-frontal cortex is last to develop and most sensitive to perinatal insults BRAIN STUDY
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Elimination diets (inflammation, autoimmune, Whole30) Sugar Food dyes Lack of outdoor time (Nature Deficit Disorder) and natural sunlight Dysfunctional parenting—no limits, chaos CONTROVERSIAL IDEAS
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Seizure disorders Sleep disorders Hearing or vision problems Medical disorders (thyroid, illnesses) PTSD, anxiety, depression, substance abuse Learning or cognitive disability OTHER DIAGNOSES THAT LOOK LIKE ADHD
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Results of MTA study guide treatment Pharmacological and non pharmacological treatments TREATMENT
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STIMULANTS: methylphenidate (Ritalin) amphetamine MEDICATIONS
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NON-STIMULANTS: atomoxetine buproprion tri-cyclic anti-depressants guanfacine, clonidine, intuniv modafinil (Provigil) MEDICATIONS
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Dopamine and norepinepherine re-uptake inhibitors in the pre-frontal cortex Pre-frontal cortex is the “filter”—helps to attend to important things, ignore unimportant Stimulants activate the pre-frontal cortex and aid filter skills and executive function skills STIMULANTS
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Goal is to improve distractibility, hyperactivity, impulsivity FDA indicated to treat ADHD Methylphenidate and amphetamine are two separate categories, both efficacious –75% with first trial, 85% with two trials STIMULANTS
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Decreased appetite, insomnia, irritability Slightly increased BP and HR 1/400 experience psychosis Some small reduction in ht and wt trajectory while taking them but long term effect unknown May or may not exacerbate a tic STIMULANT SIDE EFFECTS
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Short acting: Ritalin (5-60mg/day) Intermediate: Metadate (20-60mg/day) Ritalin LA Long acting: Concerta (18-72mg/day) Focalin XR (5-30mg/day) Daytrana patch (10-30mg/day) METHYLPHENIDATE PREPARATIONS
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Short acting: Dexedrine (5-40mg/day) Intermediate: Adderall (2.5mg-40mg/day) Long acting: Adderall XR (10-40mg/day) Lisdexamphetamine (Vyvanse)(30-70mg/day) AMPHETAMINE PREPARATIONS
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Significant abuse potential, especially short acting “pharming” Children with ADHD have a 2.5 fold increase in the risk for any substance abuse disorder including nicotine, alcohol, marijuana, and diversions of prescription medications Research suggests that 16-23% of school-aged children are approached to sell, buy or trade their stimulant medication STIMULANTS
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Misuse of stimulant medication common (5-9% of grade school and high school aged children and 5-35% college aged) Methods to reduce the risk for misuse: long-acting formulations, ensure that the DX is correct, educate family regarding the risks for misuse, provide guidance during the transition of medication from parent to child, using non-stimulant medications STIMULANTS
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ATOMOXETINE (Strattera)—norepinephrine re-uptake inhibitor FDA approved for ADHD Good second line choice when stimulants not tolerated or risk of diversion or AODA Not as effective as long-acting stimulants Side Effects: sedation, nausea, poor appetite NON-STIMULANTS
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Provides 24 hr coverage, effect starts after 2-4 weeks, 25-100mg/day, can give once a day Black Box warning regarding suicidal ideation ATOMOXETINE
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Centrally acting anti-hypertensive medications FDA approved for ADHD GUANFACINE (1-4mg/day) Intuniv= long acting form Side effects: sedation, orthostatic hypotension CLONIDINE (0.1-0.4mg/day) Long acting form Kapvay Alpha-2-agonists
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Buproprion: helpful with ADHD comorbid with depression. Do not use if seizure history Tri-cyclic antidepressants: need to monitor EKG @ baseline and follow-up, blood levels; weight gain Modafinil: likely mechanism dopamine reo-uptake, not first line med NON-FDA APPROVED NON-STIMULANTS
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Cognitive Therapy: specific exercises to train attention, working memory, impulsivity via ongoing feedback to reinforce correct responses Neurofeedback: recent study showed this to be better than CT; in neurofeedback child receives immediate auditory and visual feedback re his level of attention during the exercises; significant improvement sustained over 6 months with reduced med doses; likely due to plasticity in pre-frontal cortex NON- PHARMACOLOGICAL TREATMENT
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Groups, practice, reward Implications for school nurses Questions BEHAVIOR THERAPY