Working with children with ADHD and their families takes a great deal of patience, understanding, and encouragement. It also requires the nurse to be specially trained, or at least educated on the disorder; this will hopefully stop misdiagnosis and children becoming lost in the system. Many adults, who show symptoms of ADHD, were not diagnosed as children and now show marked incidences of depression, low self-esteem, and underachievement (Craig 1996). Without early recognition and intervention individuals can become labelled as ‘challenging’, sadly this is the case for many of the people with whom I have worked.
These people become so frustrated with their ADHD, magnified by their learning disability, that their behaviours become so extreme they require specialist intervention in either adult or children’s challenging behaviour units. This can and often does lead to a life of institutionalisation and compounded problems. Need this be the case? As Weeks and Laver-Bradbury (1997) point out “the vicious cycle of pre-school behaviour problems, school failure and adolescent and adult social malfunction needs to be tackled early”, nurses are in prime position to help achieve this if given the skills and resources to do so.
Early intervention by nurses/health visitors could see a reduction of people with ADHD coming into the healthcare system needing specialist care. The nurse also has the opportunity to recognise previously undiagnosed individuals with ADHD (Craig 1996), and can then structure treatment for individuals, starting with education about the disorder, teaching people how to structure their lives in order to achieve set goals, and referring them to appropriate specialists.
There is much debate on the subject of ADHD; in order to bring to a close some of these debates, there needs to be a coming together of minds so that discrepancies in the diagnosis, treatment and management can be ‘ironed out’. If a worldwide agreement on ADHD could be reached then perhaps the confusion experienced by affected individuals and their carers may be dispelled. There needs to be a great deal more research done into the role of the nurse in ADHD, this would hopefully highlight the important function nurses can play.
At present there appears to be very little research in this area and so it is not surprising that the exact part a nurse can play is unclear. Once this role has been researched and evaluated, then training programs can be set up in order to bring the education and the skills of the nurse up to speed with the demands shown by those affected by ADHD. Doesn’t understand the importance of food and mealtimes Meal times are social occassions Can be distracted by family members, T. V. and friends. Eliminating May forget to tell when toilet is needed Maybe hard to toilet train due to poor concentration May be affected by environment they are in i. e. school or home Personal cleansing and dressing May not clean properly due to hyperactivity, restlessness.
Accidents may occur in bathroom. May become isolated due to poor hygiene. Maybe teased due to poor hygiene, or cleanliness of clothes. Lack of temperature regulators may lead to scolding in baths. Accidental use of dangerous chemicals to wash Controlling body temperature May overheat due to hyperactivity. May not wear suitable clothing in the cold/hot Mobilising Problems may arise if fractures occur May cause frustration, more tantrums May not be able to attend school etc. Poor lay out of houses schools. Cost of taxi’s, transport etc.
Working and playing Hyperactivity, impulsivity will affect work and play Frustration at inability to complete work/play. Boredom with tasks. Where work takes place, quiet rooms, additional help/tutoring May not be able to hold down jobs, get qualifications Expressing sexuality May masturbate inappropriately. May not understand boundary issues May approach persons in an inappropriate manner due to impulsivity Sleeping Lack of sleep Frustration, aggression, affect on carers Sleeping arrangements Dying Suicide/Parasuicide Does not understand dangers. Can’t stop impulsive acts Availability of dangerous objects ADHD
Reference List
AMERICAN PSYCHIATRIC ASSOCIATION (1980) Diagnostic & Statistical Manual of Mental Disorders, 3rd edition. Washington, D. C: American Psychiatric Association. AMERICAN PSYCHIATRIC ASSOCIATION (1994) Diagnostic & Statistical Manual of Mental Disorders, 4th edition. Washington, D. C: American Psychiatric Association. BARKLEY, R. A. (1998) Attention Deficit Hyperactivity Disorders. A Handbook for Diagnosis and Treatment. New York: Guilford Press. BENDER, W. N. (1995) Learning Disabilities: Characteristics, Identification, and Teaching Strategies. 2nd ed. , London: Allyn & Bacon. BENSON, S. (1987) Biophysical Intervention Strategies.
Cited in BENDER, W. N. (1995) Learning Disabilities: Characteristics, Identification, and Teaching Strategies. 2nd ed. , London: Allyn & Bacon. BIEDERMAN, J. , FARAONE, S. V. , KEENAN, K. , KNEE, D. (1990) ‘Family-genetic and Psychosocial risk factors in DSM-111 Attention Deficit Disorder. Cited in MUNDEN, A. and ARCELUS, J. (1999) The AD/HD Handbook: A Guide for Parents and Professionals on Attention Deficit / Hyperactivity Disorder. London: Jessica Kingsley Publishers Ltd. BRITISH MEDICAL ASSOCIATION and ROYAL PHARMACEUTICAL SOCIETY OF GREAT BRITAIN (2001) British National Formulary. London: BMJ Books.