Nursing Children and Young People with ADHD

271 Pages·2009·2.75 MB·English

by  Noreen Ryan

Nursing Children and Young People
with ADHD
ADHD is one of the most commonly diagnosed behavioural disorders in
children and young people. It is a complex and contested condition, with
potential causes and treatments in biological, psychological and social
domains. This is the first comprehensive text for nurses and other health
professionals in this field.
Nursing Children and Young People With ADHD explores the evidence,
incorporating and expanding on the new NICE guidelines for practice in this
area, to provide an essential knowledge base for practice. The text covers:
causes, diagnosis, comorbidity, user and carer perspectives, assessment,
treatment and interventions (including those suitable for use in schools),
prescribing and the legal background.
An invaluable text for pre-registration student nurses on mental health and
children branches, this will also be a useful reference work for post-
registration nurses and health professionals seeking evidence-based recom-
mendations for practice.
Noreen Ryan is Nurse Consultant within Child and Adolescent Mental
Health Services for Bolton Hospitals Trust. She is part of the NICE practice
guidelines development group for the assessment and treatment of ADHD in
children, adolescents and adults.

Tim McDougall is Nurse Consultant within Child and Adolescent Mental
Health Services in Cheshire and Merseyside and a project manager within the
Cheshire and Merseyside Child Health Development Programme.

Nursing Children and
Young People with
ADHD
Noreen Ryan and
Tim McDougall
First published 2009
by Routledge
2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
Simultaneously published in the USA and Canada
by Routledge
270 Madison Ave, New York, NY 10016
Routledge is an imprint of the Taylor & Francis Group, an informa business
This edition published in the Taylor & Francis e-Library, 2008.
“To purchase your own copy of this or any of Taylor & Francis or Routledge’s
collection of thousands of eBooks please go to www.eBookstore.tandf.co.uk.”
© 2009 Noreen Ryan and Tim McDougall
All rights reserved. No part of this book may be reprinted or
reproduced or utilised in any form or by any electronic,
mechanical, or other means, now known or hereafter
invented, including photocopying and recording, or in any
information storage or retrieval system, without permission in
writing from the publishers.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging-in-Publication Data
McDougall, Tim.
Nursing children and young people with ADHD / Tim McDougall
and Noreen Ryan.
p. ; cm.
Includes bibliographical references.
1. Attention-deficit hyperactivity disorder—Nursing.
2. Attention-deficit disorder in adolescence—Nursing. I. Ryan,
Noreen, 1963– II. Title.
[DNLM: 1 Attention D eficit Disorder with Hyperactivity.
2. Adolescent. 3. Attention Deficit Disorder with Hyperactivity—
nursing. 4. Child. WS 350.8.A8 M137n 2009]
RJ506.H9M42366 2009
618.92'8589—dc22 2008028833
ISBN 0-203-88423-X Master e-book ISBN
ISBN 10: 0–415–45410–7 (hbk)
ISBN 10: 0–415–45411–5 (pbk)
ISBN 10: 0–203–88423–X (ebk)
ISBN 13: 978–0–415–45410–0 (hbk)
ISBN 13: 978–0–415–45411–7 (pbk)
ISBN 13: 978–0–203–88423–2 (ebk)
For my husband David for his unending love and for my parents
Maisie and Jim, always missed and remembered.
Noreen
For my wonderful children: Amy, Sam and Jack.
Tim

Contents
List of figures and tables xi
Notes on authors xiii
Foreword xv
Preface xvi
Acknowledgements xvii
List of abbreviations xviii
Introduction: setting the scene 1
1 What is ADHD, and what is not? 5
What is ADHD? 6
ADHD: a worldwide phenomenon? 8
Gender differences 12
What causes ADHD? 13
How can we distinguish ADHD from normal
child development? 14
ADHD and genetics 17
Pregnancy and birth 18
ADHD and the brain 18
Environmental factors 20
How important is d iet? 20
Understanding complex issues 22
Summary 24
2 Diagnostic frameworks and ADHD 26
Introduction 27
Diagnostic frameworks 27
Impairment 28
International Classification of Diseases 29
Diagnostic and Statistical Manual of
Mental Disorders 30
Nursing diagnosis: friend or foe? 34
Summary 35
viii Nursing Children and Young People with ADHD
3 Assessment and diagnosis 36
Introduction 36
Multi-professional and multi-agency working 37
What is the nurse’s role in assessment? 40
Methods of assessment 42
Reaching a conclusion: formulation and diagnosis 51
Summary 52
Case studies 53
4 What are the costs of ADHD? 62
Introduction 62
Financial costs 63
Health costs 64
Education costs 66
Social functioning 67
Parenting and family costs 69
Antisocial and offending behaviour 71
How can nurses help reduce costs and improve outcomes? 71
Summary 73
5 Major mental health problems and ADHD 74
Introduction 74
Conduct problems 75
Depression and anxiety 77
Bipolar disorder 78
Psychosis 79
Autistic spectrum disorders 79
Tic disorders 80
Attachment and separation 81
Learning difficulties and disability 81

Substance misuse 82
Other disorders of childhood 82
Summary 83
6 What do children, young people and families
tell us about living with ADHD? 84
Introduction 85
What does research tell us? 85
Being labelled 86
Taking medication 87
Difficulties at home 90
Difficulties at school 91
Contents ix
Feeling different 91
What do parents tell us? 92
What do siblings tell us? 97
Summary 99
7 Treatment and management strategies 101
Introduction 102
What are the objectives for treatment? 102
Treatment with medication 103
Psychosocial interventions 111
Parenting programmes 112
Individual psychological treatments 115
The Multimodal Treatment Study of Children with ADHD 119
Complementary and alternative treatments 120
Psychoeducational interventions 121
Summary 122
8 Service provision and care pathways 124
Introduction 125
How do children get referred to specialist services? 125
What is the role of practice parameters and clinical
guidelines? 128
Care planning 131
What is the role of ADHD support groups? 132
Summary 132
9 School-based interventions for ADHD 134
Introduction 134
School-based mental health services 135
ADHD or something else? 139
Inattention in schoo l 139
Hyperactivity in school 141
Impulsivity in school 142
Tests and rating scales 143
Teaching strategies and lesson planning 144
Creating structure and consistency 145
Medication in school 148
Social skills building 150
Liaison with specialist CAMHS 150
Summary 153