Boyd 8e

796

UNIT VII • Care of Children and Adolescents

Safety Issues Due to increased impulsivity and inattention, children and adolescents with ADHD are at greater risk for injury than those without ADHD. Research finds that children with ADHD are significantly more likely to experience injury when riding a bike, have more head injuries and injuries to multiple body parts, and are more likely to be hospitalized for unintentional poisoning. Teenagers with ADHD are more likely to break traffic rules and are more likely to be involved in a car accident than those without ADHD (CDC, 2024b). Individuals of all ages with ADHD are at high risk for mood changes that could lead to risk-taking behavior and suicidal ideation or attempts. Mood lability, the presence of depression, and potential for self-harm should be carefully assessed in these individuals. The risk of suicide attempts in children and adolescents with ADHD may be increased due to possible exposure to certain environ mental risk factors, such as poor performance in school, impaired interpersonal relationships, socioeconomic hardship, depression, and substance use (Lin et al., 2023; Todzia-Kornas et al., 2024). Studies find that hospitalized patients with ADHD are twice as likely to have suicidal ideation/attempts than those without ADHD (Trivedi et al., 2023). EVIDENCE-BASED NURSING CARE FOR CHILDREN WITH ATTENTION-DEFICIT HYPERACTIVITY DISORDER The planning of nursing interventions must be done within the context of the family, treatment setting, and school environment. With the parents, clinical team members, and school personnel, the nurse participates in designing a plan of care that fits the child’s and fam ily’s needs. Individuals with ADHD and their families will benefit from nursing care at many different times in the course of the disorder. Unless hospitalized for a comorbid mental health issue, most treatment will occur Eng, A. G., Bansal, P. S., Goh, P. K., Nirjar, U., Petersen, M. K., & Martel, M. M. (2024). Evidence-based assessment for attention-deficit/hyperac tivity disorder. Assessment , 31 (1), 42–52. PURPOSE: Review best-practice evidence-based assessment of ADHD. FINDINGS: Assessment of ADHD should include both ADHD-specific and broadband rating scales from multiple informants. IQ, academic achievement, and executive functioning should be evaluated when there are concerns about learning. For children under the age of 12, parent and teacher ratings should be averaged. For those over

outside the mental health system. School nurses often provide most of the nursing care and family education. RECOGNIZING CUES: RELEVANT ASSESSMENT INFORMATION In the school setting, the primary focus of the assessment is the impact of ADHD on classroom behavior and school performance. In the hospital, the nurse tries to determine the contribution of ADHD to the acute psychiatric issue. In both cases, the nurse collects assessment data through direct interview, observation of the child and parent, and teacher ratings. Because children with ADHD may have difficulty sitting through long sessions, interviews are typically brief. Parents and teachers are extremely important sources for assessment data (Box 37.5). To this end, the nurse can make use of several standardized instruments (Box 37.6). Physical Health As with other psychiatric disorders with onset in child hood, the nursing assessment of children with ADHD begins with identification and exploration of the presenting issues, usually hyperactivity, impulsivity, and inattention. This typically entails a review of the child’s developmental course, the onset and pattern of the cur rent symptoms, factors that have worsened or improved the child’s issues, and prior treatment or self-initiated efforts to remedy the situation. Medical history is also essential, consisting of perinatal course, childhood ill nesses, hospital admissions, injuries, seizures, tics, phys ical growth, general health status, and date of the child’s last physical examination. The behavior of these children is characteristically very active and can often be observed in the office. They cannot sit still. They fidget. Even in sleep, they may be more active than other children. Thus, a careful assessment of eating, sleeping, and activity patterns is essential. Assessing daily food intake, typical diet, and fre quency of eating will help identify any nutritional issues. 12 years old, when self and other reports are inconsistent, the informant reports should be prioritized. IMPLICATIONS FOR NURSING: Inaccurate assessment leads to undiagnosed and untreated ADHD. Evidence-based assessment is essential for accurate assessment and early intervention. Although much is known about evi dence-based assessment, more research is needed about assessment among varied populations. Females with ADHD are underidentified, and this may be due to lack of comprehensive assessment. Another heavily understudied area of ADHD assessment is the impact of race and ethnic ity. A multipronged assessment approach is needed.

BOX 37.5 Research for Evidence-Based Practice: Evidence-Based Assessment for ADHD

Copyright © 2026 Wolters Kluwer, Inc. Unauthorized reproduction of this content is prohibited.