and intrusive at home, which causes friction with
siblings and parents. Until the child is diagnosed and
treated, parents often believe that the child is willful,
stubborn, and purposefully misbehaves. Generally
measures to discipline have limited success; in some
cases, the child becomes physically out of control,
even hitting parents or destroying family posses-
sions. Parents find themselves chronically exhausted
mentally and physically. Teachers often feel the same
frustration as parents, and day care providers or baby-
sitters may refuse to care for the child with ADHD,
which adds to the child’s rejection.
PHYSIOLOGIC AND SELF-CARE
CONSIDERATIONS
Children with ADHD may be thin if they do not take
time to eat properly or cannot sit through meals. Trou-
ble settling down and difficulty sleeping are problems
as well. If the child engages in reckless or risk-taking
behaviors, there also may be a history of physical
injuries.
Data Analysis and Planning
Nursing diagnoses commonly used when working
with children with ADHD include the following:
- Risk for Injury
- Ineffective Role Performance
- Impaired Social Interaction
- Compromised Family Coping
Outcome Identification
Treatment outcomes for clients with ADHD may
include the following:
- The client will be free of injury.
- The client will not violate the boundaries of
others. - The client will demonstrate age-appropriate
social skills. - The client will complete tasks.
- The client will follow directions.
Intervention
Interventions described in this section can be adapted
to various settings and used by nurses and other
health professionals, teachers, and parents or care-
givers.
ENSURING SAFETY
Safety of the child and others is always a priority. If
the child is engaged in a potentially dangerous activ-
490 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS
ity, the first step is to stop the behavior. This may re-
quire physical intervention if the child is running
into the street or attempting to jump from a high
place. Attempting to talk to or reason with a child en-
gaged in a dangerous activity is unlikely to succeed
because his or her ability to pay attention and to lis-
ten is limited. When the incident is over and the child
is safe, the adult should talk to the child directly about
the expectations for safe behavior. Close supervision
may be required for a time to ensure compliance and
to avoid injury.
Explanations should be short and clear, and the
adult should not use a punitive or belittling tone of
voice. The adult should not assume that the child
knows acceptable behavior but instead should state
expectations clearly. For example, if the child was
jumping down a flight of stairs, the adult might say,
“It is unsafe to jump down stairs. From now on, you
are to walk down the stairs, one at a time.”If the child
crowded ahead of others, the adult would walk the
child back to the proper place in line and say, “It is
not OK to crowd ahead of others. Take your place at
the end of the line.”
To prevent physically intrusive behavior, it also
may be necessary to supervise the child closely while
he or she is playing. Again, it often is necessary to act
first to stop the harmful behavior by separating the
child from the friend such as stepping between them
or physically removing the child. Afterward the adult
should clearly explain expected and unacceptable
behavior. For example, the adult might say, “It is not
OK to grab other people. When you are playing with
others, you must ask for the toy.”◗ INTERVENTIONS FORADHD
- Ensuring the child’s safety and that of others
Stop unsafe behavior.
Provide close supervision.
Give clear directions about acceptable and
unacceptable behavior. - Improved role performance
Give positive feedback for meeting expectations.
Manage the environment (e.g., provide a quiet
place free of distractions for task completion). - Simplifying instructions/directions
Get child’s full attention.
Break complex tasks into small steps.
Allow breaks. - Structured daily routine
Establish a daily schedule.
Minimize changes. - Client/family education and support
Listen to parent’s feelings and frustrations.