ATTENTION DEFICIT AND

DISRUPTIVE BEHAVIOR
DISORDERS

By: Kristine Charisse V. Tanedo

BSN3 MSU-IIT
HYERACTIVITY DISORDER
(ADHD)
 -characterized by in attentiveness, over
activity and impulsiveness
 -common disorder, especially in boys
 -essential feature: persistent pattern of
in attention and hyperactivity and
impulsivity
 -high serotonin and norepinephrine

ONSET AND CLINICAL COURSE

 SYMPTOMS:
 Infants:
 -often fussy and temperamental
 -have poor sleeping patterns
 Toddlers:
 -always on the go
 -into everything
 -dart back and forth
 -jump and climb into furniture
 -run through the house
 -cannot tolerate sedentary activities such
as listening to stories

ONSET AND CLINICAL
COURSE
 School Age: symptoms begin to interfere
significantly with behavior and
performance
 -fidgets constantly
 -is in and out of assigned seats
 -make excessive noise by tapping or
playing with pencils and other objects
 -easily distracted by normal
environmental noises (eg: coughing)
 -child interrupts and blurts out
answers before questions are completed

ONSET AND CLINICAL
COURSE
 Adolescence: two-thirds of children dx with
ADHD continue to have problems in
adolescence
 ; possess typical impulsive behaviors
 -cutting classes
 -getting speeding tickets
 -failing to maintain interpersonal
relationships
 -adopting risk-taking behaviors such as
using drugs or alcohol, engaging in premarital
 sex, fighting, violating curfew
 -other discipline problems that often lead to
expulsion or warrant suspension of students
from school
ONSET AND CLINICAL
COURSE
 Adults in whom ADHD was dx in childhood
have higher rates of impulsivity, alcohol
and drug use, legal troubles and
personality disorders.

ETIOLOGY
 Cause: Unknown
 Factors:
 Environmental toxins
 Prenatal influences
 –exposure to alchohol, tobacco, lead, severe
malnutrition in early childhood
 Heredity
 -seems to have a genetic link that is likely
associated with abnormalities in
Cathecholamin and possibly serotonin
metabolism
 Damage to brain structures
- brain images have suggested a decrease
metabolism in frontal lobes
 -decreased blood perfusion of the frontal
cortex in children
 -frontal atrophy in young adults with ADHD
RISK FACTORS:

 Family history
 Male relatives with antisocial personality disorder or
alcoholism
 Female relatives with somatization disorder
 Lower socioeconomic status
 Male gender
 Marital or family discord – divorced
 Neglect
 Abuse
 Parental deprivation
 Low birth rate
 Various kinds of brain insult

CULTURAL CONSIDERATIONS:

 -ADHD is known to occur in various

cultures and is more prevalent in
Western cultures.

TREATMENT:

 -no one treatment has been found

effective; ADHD is chronic
 -Most effective combines:
PHARMACOTHERAPY WITH BEHAVIORAL,
PSYCHOSOCIAL AND EDUCATIONAL
INTERVENTIONS

Goals of treatment:

 Managing symptoms
 Reduce hyperactivity and impulsivity
 Increase child's attention so that he can
grow and develop normally

PHARMACOTHERAPY:

 Stimulants:
 Give stimulants during daytime hours to
combat insomnia.
 Eating a good breakfast with the morning
does and substantial nutritious snacks
late in the day and at bedtime will help
the child to maintain an adequate
dietary intake,

Stimulants:

 Most COMMON:
 Methylphenidate (Ritalin)
 Amphetamine compound (Adderall)

 OTHER STIMULANTS :
 Dextroamphetamine (Dexedrine)
 Pemoline (Cylert) –last drug
because it causes liver damage
  
  

Stimulants:

 Side effects:
 insomnia
 loss of appetite
 weight loss or failure to gain weight

PHARMACOTHERAPY:
Antidepressants
 Antidepressants – second choice for
treatment
 ATOMOXETINE (STRATTERA)


 Side effects:
 In children –nausea, vomiting,
tiredness, decreased appetite, upset
stomach
 In adults – insomnia, dry mouth,
urinary retention, decreased appetite,
nausea
STRATEGIES FOR HOME AND
SCHOOL
 Therapeutic play –often used to
understand the child’s thoughts and
feelings and to promote communication
 Dramatic play – acting out an anxiety-
producing situation such as allowing the
child to be a doctor or use a stethoscope or
other equipment to take care of a patient
(a doll)
 Play techniques to release energy
includes:
 Pounding pegs
 Running
 Working with modeling clay
 Creative play – can help children to express
themselves
INTERVENTIONS:
 Ensuring the child’s safety and that of others
 Stop unsafe behavior
 Provide close supervision
 Give clear directions about acceptable and
unacceptable behavior
 Improved role performance
 Give positive feedback for meeting expectations
 Manage the environment (quiet place free of
distractions)
 Simplifying instructions/directions
 Get child’s full attention
 Break complex tasks into small steps
 Allow breaks
 Structured daisly routine
 Establish a daily schedule
 Minimize changes
 Client/family education and support
 Listen to parent’s feelings and frustrations