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UNIT VII • Care of Children and Adolescents

Family Interventions Unfortunately, lack of integration of medical, psychiatric, social, and educational services can add to the family’s bur den. Parents may manifest denial, grief, guilt, and anger at various points as they adjust to their child’s disability. The nurse can offer parents the opportunity to express their frustrations and disappointments and can be alert for indications that parents need additional assistance, such as parent support groups or respite care. Family interventions include support, education, coun seling, and referral to self-help groups. Whenever possi ble, the nurse provides education to help parents deter mine appropriate expectations for their child and to meet the child’s special needs. The following are examples of potentially useful nursing interventions focusing on the family: • Interpreting the treatment plan for parents and child • Modeling appropriate behavior modification tech- niques • Including the parents as co-therapists for the imple mentation of the care plan • Assisting the family in identifying and resolving their sense of loss related to the diagnosis • Coordinating support systems for parents, siblings, and family members • Maintaining interdisciplinary collaboration Evaluation of Patient Outcomes Evaluation of patient and family outcomes is an ongoing process. Short-term outcomes might consist of discrete behavioral improvements, such as reducing self-injurious behavior by 50%. The long-term goal is for the patient to achieve the highest level of functioning. ATTENTION-DEFICIT HYPERACTIVITY DISORDER ADHD is one of the most commonly diagnosed disor ders in school-aged children (CDC, 2024b). It is almost certainly a heterogeneous disorder with multiple etiolo gies. The relatively high frequency of ADHD and associ ated behavior issues virtually guarantees that nurses will meet affected children in all pediatric treatment settings. ADHD is also diagnosed in adults, but it is less common than in children (Popit et al., 2024). Diagnostic Criteria and Clinical Course A persistent pattern of inattention, hyperactivity, and impulsiveness that interferes with functioning character izes ADHD (APA, 2022). A diagnosis is made based on school behavior, parents’ reports, and direct observation

of inattention and hyperactivity–impulsivity that are inconsistent with developmental level. Parents and teach ers describe children with ADHD as restless, always on the go, highly distractible, unable to wait their turn, heedless, and frequently disruptive. It is often disruptive behavior that brings these children in for treatment. KEYCONCEPT Attention involves concentrating on one activity to the exclusion of others, as well as the ability to sustain focus. In ADHD, the individual finds it difficult to attend to one task at a time and is easily distracted. For some, the lack of attention is related to being unable to filter incoming information, which leads to being unable to screen and select the important information. That is, all incoming stimuli are treated the same (e.g., directions from a teacher elicit the same importance as noise in the hallway). For others, the distractibility may be related to stimuli-seeking behavior. Given the heterogeneity of ADHD, either of these models may explain issues of attention for subgroups of affected children. Children with ADHD are prone to impulsive, risk-­ taking behavior and often fail to consider the consequences of their actions (CDC, 2024b). They tend to demonstrate poor judgment and seem to have more accidental injuries due to their risk-taking behavior. They often require a high degree of structure and supervision (Lillvis et al., 2024). KEYCONCEPT Impulsiveness is the tendency to act on urges, notions, or desires without adequately considering the conse quences. Although hyperactivity is a characteristic often asso ciated with ADHD, controversy is long-standing about whether attention-deficit disorder can occur without overactivity. In many cases, it is the hyperactivity that prompts the search for treatment. Parents typically report that a child’s hyperactivity was manifested early in life and is evident in most situations (APA, 2022). Hyperactivity and impulsivity in childhood are associated with increased risk of being involved in cases of violence, particularly intimate partner violence and sexual violence, either as victims or perpetrators (Arrondo et al., 2023). KEYCONCEPT Hyperactivity is excessive motor activity, as evidenced by restlessness, an inability to remain seated, and high ADHD is usually diagnosed in childhood and was traditionally viewed as an issue of children. We now understand that ADHD persists into adulthood, and it is sometimes first diagnosed later than in childhood. In adults, symptoms of hyperactivity and impulsivity tend to decline with age and deficit of attention persist and become more varied. However, most adults with ADHD are undiagnosed and untreated (Plowden et al., 2022). levels of physical motion and verbal output. ADHD Across the Lifespan

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