Pediatric Nursing Q 154
The school nurse assesses Brook, a child newly diagnosed with attention deficit hyperactivity disorder (ADHD). Which of the following symptoms are characteristic of the disorder? Select all that apply.
A. Constant fidgeting and squirming
B. Excessive fatigue and somatic complaints
C. Difficulty paying attention to details
D. Easily distracted
E. Running away
F. Talking constantly, even when inappropriate
Correct Answer: A, C, D, & F
These behaviors are all characteristic of ADHD and indicate that the child is inattentive, hyperactive, and impulsive. Individuals suffering from this disorder show patterns of developmentally inappropriate levels of inattentiveness, hyperactivity, or impulsivity. Although there used to be two different diagnoses of Attention Deficit Disorder vs Attention Deficit Hyperactivity Disorder, the DSM IV combined this into one disorder with three subtypes: predominantly inattentive, predominantly hyperactive, or combined type.
Option A: The symptoms begin at a young age and usually include lack of attention, lack of concentration, disorganization, difficulty completing tasks, being forgetful, and losing things.
Option B: This can be a sign of emotional distress in a child and could be associated with a number of different psychiatric diagnoses. In order to diagnose ADHD, it is very important to take a relevant history of the concerned individual. ADHD is diagnosed in children based upon their history where the children face difficulty in at least 6 of the 9 symptoms as mentioned in DSM 5.
Option C: This symptom must be present in more than one setting (ie at home and at school, or at school and at after-school activities). It can have large consequences including social interactions, increased risky behaviors, loss of jobs, and difficulty achieving in school.
Option D: ADHD must be considered within the context of what is developmentally and culturally appropriate for a person. It is considered a dysfunction of executive functioning, predominantly a frontal lobe activity. Therefore, patients with ADHD show disability not only in attention and focus but also in decision making and emotional regulation.
Option E: For children, the Vanderbilt ADHD scale is often used as it has both a teacher and parent component. A physical examination, on the other hand, is not as useful in the diagnosis of ADHD but it can still be used to exclude medical causes such as thyroid problems.
Option F: Children with ADHD can have difficulty with social interactions, can be easily frustrated, and can be impulsive. They are often labeled as “troublemakers.” Hyperactive symptoms include: fidgeting, feeling like an “internal motor” is always going, leaving their seat, climbing on things, being loud, blurting out answers, talking excessively or out of turn, having trouble waiting their turn, interrupts, or intrudes on others. These symptoms must be present in multiple settings.