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CHAPTER 37 • Mental Disorders of Childhood and Adolescence

Because ADHD often occurs in the context of psy chosocial adversity, it is important to review the family situation, including parenting style, stability of house hold membership, consistency of rules and routines, and life events (e.g., divorce, moves, deaths, job loss). Identification of these factors can be useful in shaping a care plan that builds on potential strengths and mitigates the effects of environmental factors that may perpetuate

Caffeinated products can contribute to hyperactivity in some children. Sleep is often disturbed for children with ADHD and consequently also the family. A detailed sleep assessment can provide points for interventions and help the interpretation of drug effects. Psychosocial Cues Data regarding school performance, behavior at home, and comorbid psychiatric disorders are essential for developing school interventions and behavior plans and establishing the baseline severity for medication. Children with ADHD are more likely to have issues with their cognitive process during changing demands of teachers and parents (cognitive processing, attention, language, and memory) (Sadozai et al., 2024). Consequently, they may have more difficulty in school with decision-making. These children are often behind in their work at school because of poor organization, off-task behavior, and impulsive responses (Shroff et al., 2024). Dysfunctional interactions can develop within the fam ily. Discipline is frequently an issue because parents may have difficulty controlling their child’s behavior, which is disruptive and occasionally destructive. They can exhaust their parents, aggravate teachers, and annoy siblings with their intrusive and disruptive actions. Reviewing the problematic behaviors and the situations in which they occur is a way to identify negative interaction patterns. BOX 37.6 Standardized Tools for Attention-Deficit Hyperactivity Disorder Diagnosis a CONNERS QUESTIONNAIRES The Conners Parent Questionnaire is a 48-item scale that a parent completes about their child. Each item is a state ment that the parent rates on a 4-point scale from 0 (not at all) to 3 (very much). The Conners Teacher Questionnaire is a 28-item questionnaire that the child’s teacher com pletes according to the same 4-point scale as the Parent Questionnaire. Both questionnaires have been standard ized by age and gender for a mean of 50 and a standard deviation of 10 (Conners, 1997; Goyette et al., 1978). CHILD BEHAVIOR CHECKLIST The Child Behavior Checklist (CBCL) is a 118-item ques tionnaire that a parent completes. In addition to the 118 questions about specific behaviors and psychiatric symptoms, the CBCL also includes questions concerning the child’s competence in social and academic spheres as well as age-appropriate activities. Normative data are available, allowing the conversion of raw scores to stan dard scores for age and gender. A teacher version of this scale is also available. a Note that the diagnosis of ADHD is not made on the basis of questionnaires alone. Data from these rating scales augment the information gathered through interview and observation. These questionnaires can be especially useful before and after initiating a treatment plan to measure change.

the child’s disruptive behavior. ANALYZING CUES AND DEVELOPING HYPOTHESES

Priorities of nursing care will depend on the severity of the responses, family situation, and school environment. Increased impulsivity and inattention put the child or adolescent at greater risk for injury. Comorbid disorders, such as mood or conduct disorders, may also be present. Sleep deprivation, inadequate nutrition, and the inability to carry out daily routines may require intervention. The child may demonstrate poor coping skills and may not function well in social settings or in structured activities

(such as in the school environment). PLANNING RECOVERY AND WELLNESS OUTCOMES

Outcomes should be individualized to the child. Short term outcomes, such as decreasing the number of class room ejections within a 2-week period, may be useful for one child, but reducing the frequency and amplitude of angry outbursts at home may be relevant to another child. TAKING ACTION: NURSING INTERVENTIONS Physical and psychosocial development must be con sidered when developing interventions for children and adolescents. Just as family relationships change during growth development, ADHD symptoms also change and influence the child and family’s abilities to cope with these changes. Physical Care The following discussion of physical is applicable to children and adolescents. As a child transitions to adoles cence, the personal responsibility for these interventions shift for the parent to the adolescent. Modifying Nutrition A link between adverse reactions to food (e.g., dietary salicylates and artificially added food colors, flavors, preservatives) and ADHD was suggested many years ago

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