APNA 29th Annual Conference Session 3033: October 30, 2015 PARENT ’ S SELF - HELP TRAINING FOR IMPROVED ATTENTION DEFICIT HYPERACTIVITY DISORDERS ( ADHD ) OUTCOMES Pierre Ngili, DNP, RN, APN, PMHNP-BC R. Alexander Padilla, DNP, PMHNP-BC, RN N O CONFLICT OF INTEREST The speakers have no conflicts of interest to disclose. LEARNING OBJECTIVES As a result of participating in this session, participants will be able to: Discuss the impact of ADHD Discuss alternatives for the treatment modalities in the management of children’ ADHD symptoms Appraise the effectiveness of parents psycho-education in the management of children’s ADHD symptoms Enumerate advantages of using a remote parent training program in the management of ADHD symptoms Ngili 1
APNA 29th Annual Conference Session 3033: October 30, 2015 TYPE OF PRESENTATION This presentation intends to address a gap in knowledge, skills, and practice The GAP. Parents should attend psychoeducation and training to address ADHD symptoms but competing family and work priorities as well as lack of transportation may hinder adherence (Daley, O’Brien, 2013) Topic: Remote Parent Self-Help Program for the Management of ADHD ADHD DIAGNOSTIC CRITERIA A persistent pattern of inattention and/or hyperactivity-impulsivity Several symptoms present before age 12 Six or more symptoms for each type present and interfering with social, occupational or academic performance for at least six months symptoms distinguished from those of oppositional defiant disorder, conduct disorders, learning disabilities or other mental disorders (American Psychiatric Association, 2013) ADHD DEFINITION ADHD is a neurodevelopmental disorder characterized by A persistent pattern of inattention and/or hyperactivity-impulsivity Interference with functioning or development” 2 Types: Inattentive/ Hyperactive/impulsive type Inattentive failure to give attention to details, careless mistakes in school work difficulty sustaining attention in tasks distraction & failure to follow through instructions, difficulty organizing avoidance & reluctance to engage in tasks that require mental effort, losing things that are necessary to complete tasks, forgetfulness in daily activities such as “doing chores or running errand ( American Psychiatric Association , 2013) Ngili 2
APNA 29th Annual Conference Session 3033: October 30, 2015 ADHD DEFINITION ( CONT ’ D ) Hyperactive and impulsive types characterized fidgeting or tapping hands inappropriately leaving seats, running about or climbing, inability to play or to engage in activity quietly, restlessness, or ‘on the go’ talkativeness, blurting out answers before the question has been asked difficulty waiting a turn, interruption of or intrusion onto others (American Psychiatric Association, 2013) A DHD PREVALENCE 2 to 10% of children in the general population may have ADHD More boys than girls affected at a rate of two to one (American Psychiatri Association, 2013) Cause of ADHD still unknown (Waite, Vlam, Irrera-Newcomb & Babcock, 2013) Neurobiological theories presume abnormalities in the central dopaminergic and noradrenergic systems due to one or a combination of Genetic predispositions exposure to toxins, infections and physical trauma (American Psychiatric Association, 2013) Other theories suspect psycho-social and environmental factors abuse, neglect violence and various forms of exposure to traumatic experiences (Block, Macdonald, & Piotrowski, 2014) IMPACT OF ADHD Due to children’ ADHD symptoms, parents May feel helpless, become more punitive or distancing which in turn can exacerbate children’ maladaptive behaviors at home, in social settings and in the school environment (Kim & Yoo, 2013) Limited knowledge about ADHD May cause parents to blame themselves for their children’s behaviors, to withdraw support and resign from caring for, or communicating with their children (Ghanizadeh, Yazdanshenas, Nasab, Firoozabadi & Farrashbandi, 2014) Children with ADHD may perceive themselves as unwanted and may revert to rebellious and more maladaptive behaviors including poor school attendance and suboptimal academic performance (Voogd, 2014) Ngili 3
APNA 29th Annual Conference Session 3033: October 30, 2015 IMPACT OF ADHD ( CONT ’ D ) Concerns that ADHD is financially taxing. Using existing data on health care and mental-health care utilization, medication utilization, education costs, juvenile delinquency costs, and work-loss costs, the estimated annual cost of ADHD to society stands at approximately $14,500 per child ($42.5 billion total). Estimated incremental education costs are approximated to be $3,400 per ADHD child annually (Robb, et al. 2011) Number of children diagnosed with ADHD in 2011 would have grown by 40% (Vestal, 2014) Recent increase in diagnosis not paralleled with increase in treatment (CDC, 2014). RECOMMENDED TREATMENT Medication still mainstay treatment for ADHD Combination of pharmacology and psycho-education believed to bear superior outcomes Psychosocial and multimodal interventions for extended family, parents and children recommended in addressing complex symptomatology of ADHD and in shaping the child’s behavior (Fields & Hale, 2011 Unfortunately, many parents/guardians not able to afford treatment. Evidence-based project undertaken to tackle disparities in the treatment of ADHD by providing affordable self-help training to parents/guardians of ADHD-diagnosed children/adolescents (Daley, O’Brien, 2013). RECOMMENDED TREATMENT ( CONT ’ D ) ADHD symptoms largely affect the child’ social support systems children with ADHD are more prone to disruptive behaviors and to peer and family rejections Constant exposure of the family to maladaptive ADHD behaviors is a source of potential emotional exhaustion and family stressful relationships (American Psychiatric Association, 2013) Focus treatment modalities on the family and view the child’s symptoms from an integrated system (Kim, & Yoo, 2013; Daley& O’Brien, 2013). Ngili 4
APNA 29th Annual Conference Session 3033: October 30, 2015 ADHD AND EFFECTIVE PARENTING Children with ADHD need proactive care to help develop adaptive skills and to prevent reoccurring problems caused by child’s maladaptive behaviors (Malek, Mashhadi, Soltanifar, Moharreri & Ghamanabad, 2014). Effective parenting requires that parents communicate and negotiate clearly with their children Nurtures achievable age-appropriate behaviors Ensures that the children understand parents’ expectations and the house rules. Praises good behaviors and provides explicit clarity for the consequences of unacceptable behaviors (Laver- Bradbury, Thompson, Weeks, Daley, & Sonuga-Barke, 2010) Respects the child and promotes learning that helps the child acquire and exercise control of his or her behavior. Effective parenting is also characterized by interactive relationship that appreciates positive points and makes the child feel good about her/himself (Laver-Bradbury, Thompson, Weeks, Daley & Sonuga-Barke, 2010). ADHD AND EFFECTIVE PARENTING ( CONT ’ D ) In Effective Parenting Parents understand and accept the child’s condition. Parents recognize that a child with ADHD needs more support, guidance and parental acceptance Parents reassure children and help them develop self-control behavioral skills (Laver-Bradbury, Thompson, Weeks, Daley & Sonuga-Barke, 2010). Effective Parenting Improves parent-child communication, makes children feel more accepted, affects pattern of interactions in the family and globally improves family relationships (Kim & Yoo, 2013). ADHD AND EFFECTIVE PARENTING ( CONT ’ D ) Effective Parenting Promotes the child’s social skills Improve child’s attention and concentration through play, attention training play, tone of voice, and importantly, discussing emotions. It entails improving the child’s communication, expanding language through play, distraction techniques, quiet time, or even timed timeout Also teaches managing the child’s ADHD symptoms outside of the house through self- monitoring, rewards, mutual respect, instructions repetition (Laver-Bradbury, Thompson, Weeks, Daley & Sonuga-Barke, 2010). Ngili 5
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