Prevalence and Overview
Attention-Deficit/Hyperactivity Disorder (ADHD) affects an estimated 9.8% of American children aged 13–17 (CDC, 2022f). Globally, about 5% of children and adolescents under 19 are diagnosed with ADHD (Wüstner et al., 2019). While occasional inattention or impulsive behavior is normal for children, ADHD involves more severe and persistent symptoms that disrupt school performance, home life, and peer relationships (CDC, 2021c). Common symptoms include:
- Daydreaming
- Forgetting or losing items
- Fidgeting or squirming
- Talking excessively
- Making careless mistakes or taking unnecessary risks
- Struggling to resist temptation
- Difficulty getting along with others
Diagnosis
ADHD diagnosis requires a multi-step evaluation by a pediatrician or mental health professional. There is no single diagnostic test. Because other conditions—such as anxiety, depression, sleep disorders, or learning disabilities—may mimic ADHD, assessment typically includes:
- Medical examination
- Hearing and vision screening
- Symptom checklists completed by parents, teachers, and the child
ADHD often persists into adulthood, with about one-third of affected children continuing to meet diagnostic criteria later in life. Adult treatment options include medication, psychotherapy, or both (CDC, 2021c).
Types of ADHD
ADHD is classified into three presentations (CDC, 2021c):
- Inattentive: Difficulty organizing tasks, following instructions, or paying attention to details; easily distracted; forgetful in daily routines. Symptoms may be mistaken for laziness.
- Hyperactive-Impulsive: Excessive fidgeting, talking, restlessness, or constant movement; impulsive behaviors such as interrupting, grabbing objects, or speaking out of turn; difficulty waiting or listening.
- Combined: Equal presence of inattentive and hyperactive-impulsive symptoms. Presentations can shift over time.
ADHD Across the Lifespan
ADHD is not limited to children. Older adults, often undiagnosed, may seek medical advice when they notice increased forgetfulness or difficulty completing tasks. Diagnosis is sometimes prompted by family history, as ADHD is one of the most heritable medical disorders (Collier, 2020).
Nursing Support for Families
Nurses play a key role in supporting families by:
- Educating parents about strategies such as consistent routines, organized environments, minimal distractions, clear instructions, and positive reinforcement.
- Encouraging exploration of extracurricular activities to build self-esteem.
- Promoting healthy habits, including balanced nutrition, physical activity, and adequate sleep.
- Referring families to community resources while considering cultural, financial, and social contexts.
Clinical and Safety Considerations (QSEN)
When caring for a client with ADHD, nurses should:
- Recognize that inattention may hinder participation in care.
- Support involvement in healthy, social activities.
- Allow decision-making time to respect individual abilities.
- Screen for co-occurring disorders (e.g., anxiety, depression, learning disabilities).
- Emphasize injury prevention due to impulsivity and risk-taking behaviors.
Medication Management
Stimulants—such as methylphenidate (Ritalin), dextroamphetamine (Dexedrine), and mixed amphetamine salts (Adderall)—are first-line treatments due to their rapid onset and proven safety record. These medications act on dopamine and norepinephrine systems and are available in short-, intermediate-, and long-acting forms.
Key considerations:
- Pre-treatment evaluation: height, weight, vitals, cardiovascular history, substance use assessment.
- Common side effects: insomnia, appetite loss, stomach pain, headache.
- Less common: tics, emotional blunting.
- Abuse potential: classified as Schedule II controlled substances; monitor for diversion or misuse.
Alternatives:
- SNRIs (e.g., atomoxetine/Strattera): helpful for comorbid depression or anxiety; no abuse potential; black box warning for suicidal ideation in youth.
- Alpha-2 adrenergic agonists (e.g., clonidine): used alone or with stimulants to reduce hyperactivity or aid sleep.
Behavioral Therapies
Behavioral interventions aim to reduce disruptive behaviors and increase positive behaviors. For children under six, parent training is the preferred first-line therapy. For those over six, a combination of medication, parent training, and school-based support is recommended (CDC, 2023e).
Community Resources
Families can access resources such as:
- National Resource Center on ADHD (CHADD, 2023): helpline, educational materials, advocacy.
- American Academy of Child & Adolescent Psychiatry ADHD Resource Center: treatment information, video guides, clinical resources.
- SAMHSA provider locator for local treatment options.