Clinical Manifestations – Attention-deficit/hyperactivity Disorder (ADHD) (Nursing)

00:00 So what are some of the clinical manifestations of ADHD? So for example, what are some examples of inattention? What we see is that the child might fail to give close attention to details.

00:18 Now this inattention to detail will continue on as part of ADHD.

00:27 They may not be able to sustain their attention in play, activities or tasks.

00:33 And so when we are asking them to do something, they may require multiple cues to get that thing accomplished.

00:43 There is also the possibility of that person being easily distracted.

00:49 And so they're trying to do one thing, but then they notice something else going on and they totally forget about the thing at hand.

01:01 This is not a willingness to not get what is at hand done.

01:07 This is a symptom, a clinical manifestation of ADHD.

01:13 And so oftentimes people will fault the child for not sustaining their attention.

01:21 But that is not under their control.

01:25 They may not be listening or appearing to listen when you speak to them.

01:31 It is important to understand that that doesn't necessarily mean that they don't hear you. If, as a nurse taking care of a child who has ADHD, you want to make sure you're heard. What do you think would be an easy and direct way to find out if they're listening? You're right.

01:54 Say, did you hear what I said? Or can you repeat what I said? Keeping your sentences short so that they don't have to repeat a long sentence.

02:06 Will really be helpful.

02:08 The child might not follow through on instruction or accomplish tasks, but that might be related to the fact that maybe they don't recall all the instructions.

02:20 Maybe they recall step one and step two, and then their attention fell off.

02:28 And so they didn't hear step three and step four.

02:31 So we sometimes think about only giving one step at a time.

02:36 And they may have organizing problems.

02:40 They might be difficult for them to organize and plan their day to get their tasks, in order to understand what activities need to be done before others.

02:52 Prioritizing because impulse is so high.

02:57 Now, if you know.

03:00 And you have no ADHD, and you know that something you're about to do is going to be a great challenge and you're going to have to work on it.

03:10 You're going to have to work on it for hours to make sure it gets done.

03:13 You might be slow to set me up to it and really get engaged.

03:18 You might actually pull a support team in to help you.

03:23 But let's consider the child.

03:25 Let's consider an eight year old, a nine year old who suddenly realizes that a task in front of them is going to require sustained mental effort when they already know that they're getting yelled at at school, they're getting yelled at at home, and they're getting yelled at by their friends because they're not completing the tasks that they are supposed to complete.

03:49 These are kids who often times will be reluctant to engage in any task that is going to require sustained mental health effort, and they may lose those things that they need in order to complete the activity.

04:07 Because there's this impulsive behavior going on with stimulus that comes in that disengages their ability to pay attention, to let me get my ducks in order.

04:23 Obviously this destructive ability.

04:28 This. Immediate distraction by any extraneous stimuli will stop whatever it is that they are doing and move them into a separate activity, leaving the last one unfinished and in many times just forgotten.

04:50 And so that forgetfulness of of what I was doing and moving into something else that allows them to suddenly start thinking about, well, what do I need to do? And then forgetting.

05:05 It is a clinical manifestation that they have difficulty getting into anything that requires sustained effort, mental effort, focus.

05:17 Attention. And their inability to accomplish activities and to meet expectations is also going to add extra emotional stress.

05:31 Because it's hard to be the person who everyone's always saying, I don't want him on my team. He never gets his things done.

05:39 He loses his stuff all the time.

05:42 He doesn't even know where his backpack is.

05:45 And children can be mean to each other when you're not the same as everyone else.

05:52 Adhd impairs a child's life in multiple arenas.

05:58 So what are some examples of hyperactivity and impulsivity that we see? So we're going to see the child who fidgets, who squirms, who taps their hands and feet.

06:10 Is this possibly a normal response of a child who's a little anxious? Yes. Children fidget.

06:18 They squirm in their seats.

06:20 They tap their hands.

06:21 They tap their feet.

06:23 They click their tongue.

06:26 The child with the clinical fidgeting can't stop.

06:32 They leave their seat.

06:34 When they are told to stay in their seat, they might get up and walk around.

06:40 They might run around the room.

06:42 They might climb on things inappropriately.

06:47 These children have often an inability to play quietly.

06:52 They seem like they're always on the go.

06:55 Once they start talking, they just keep talking.

07:00 And I believe that part of that talking excessively, that having to get it all out is a sense of control over the environment.

07:09 Because if I'm talking, I don't have to listen to what you're saying.

07:14 Sometimes if they know the answer and many children with ADHD are extremely bright children, if the teacher asks a question, they may not raise their hand.

07:27 They might just scream out the answer before the question is even completed.

07:32 They might interrupt other people.

07:35 So we want to make sure that when we're seeing these clinical manifestations, any one of the things that I've just said could occur with children who don't have ADHD.

07:47 But when it is persistent, when we see it across environments, we see it in the school, we see it at home.

07:54 We see it when they are in brownies or Boy Scouts or on the soccer field.

08:01 When we see it across these three environments and when we test a child for ADHD, we actually test across these three environments.

08:11 That's how we come to that clinical understanding that the child is not in control of these behaviors.