Attention Deficient Disorder and Dealing With Developmental Disabilities In Nursing Education
Whats Are Developmental Disabilities
The term child development refers to the physical, cognitive, and social-emotional growth that takes place throughout the period of childhood. It is sequential and measured according to a set of milestones or expected outcomes that have been established, which takes into account the variability that is present within the general population (CDC, 2017b).
These milestones measure the child's ability to demonstrate age-expected skills in areas such as language, cognition, gross and fine motor control, and social and emotional behavior.Children who do not meet developmental milestones are considered to have a developmental delay. Approximately 13% of preschool children demonstrate developmen tal delays severe enough to make them eligible for early intervention services (Rosenberg, Zhang, & Robinson, 2008).
Many of these children are simply developing at a slower than normal rate and, with intervention, will eventually achieve developmental milestones (Harstad, 2017). Others have more significant problems.
A developmental delay is a temporary or short-term challenge whereas a developmental disability represents a lifelong condition resulting from a change in the pattern or nature of a child's development.
In the United States, about one in six or 15% of children have one or more developmental disabilities (CDC, 2016a). “Children with developmental disabilities are not traveling at a slower pace; they are traveling a different route overall” (Quinn, 2000, disorders may find alternative paths to meeting developmental milestones, many are left with deficits that persist into adulthood. Examples of developmental disorders include ADHD and Down syndrome.
Another group of developmental disorders is classified as pervasive developmental disorders, which involve impairment in the development of socialization and communication skills (Office for People with Developmental Disabilities, 2017). Because socialization and communication are keys to an individual's connectedness to the world, impairments in these areas tend to permeate all areas of development (Quinn, 2000). Examples of pervasive developmental disorders include autism and Rett syndrome.
Public policy has been enacted to protect the 3 to 4 million people in the United States with developmental disabilities.
The Developmental Disabilities Assistance and Bill of Rights Act of 2000 defines developmental disabilities in broad terms as those chronic mental or physical conditions present before 22 years of age that are likely to continue indefinitely and result in substantial limitations in at least three of the following major life activities: self-care, receptive and expressive language learning, mobility, self-direction, capacity for independent living, and economic self-sufficiency (US Department of Health and Human Services [US-DHHS], 2000).
This legislation establishes state councils on developmental disabilities, university centers for excellence in disability education, research, and service; and national initiatives to collect data and provide needed assistance to individuals and families.
The Individuals with Disabilities Education Act, originally passed in 1975 as the Education for All Handicapped Children Act, addresses the educational needs of children with developmental disabilities. Amended several times since its inception, IDEA ensures that children with disabilities receive a free and appropriate public education as well as early intervention services starting with infancy.
In the latest update of IDEA in 2004, regulations include more specific classifications of developmental disabilities such as autism, emotional disturbance, hearing and visual impairment, traumatic brain injuries, learning disabilities, and mental retardation (Crandell et al., 2012; Snowman & Mc-Cown, 2015).
When working with a child with a developmental disability, it is essential that the nurse recognize the important role of parents, who are the real experts in caring for their child because they know the child best. It is a wise nurse who invites these parents to participate and assist the staff during their child's hospitalization and then works with them in the home.
Likewise, when caring for an adult with a developmental disability, caregivers are often the people who know the patient better than anyone else. However, the nurse needs to be sensitive to the arduous schedule involved in caring at home for a child or adult with a severe developmental disability and recognize that during times of illness, parents and family members are often stressed and fatigued.
Managing the treatment of persons with developmental disabilities accounts for an increasing portion of healthcare practice today. Because developmental disabilities are usually diagnosed during infancy and are likely to last a lifetime, nurses must acquire sensitivity to family issues and learn to be flexible in their approaches to meet the intellectual, emotional, and medical concerns of patients with special needs (Webb, Tittle , & VanCott, 2000). Several of the common developmental disabilities are described in detail in the following subsections.
Attention Deficit/Hyperactivity Disorder In Nursing Education
Attention deficit/hyperactivity disorder (ADHD) is a disability of both children and adults that is characterized by difficulty focusing on everyday tasks, as demonstrated by inappropriate behavior such as lack of attention and being impulsive.
Although many individuals display some symptoms of ADHD from time to time, an actual diagnosis of this problem is dependent on the individual displaying symptoms most of the time and across settings, such as at home. in school, on the playground, and at the work place. Furthermore, a child must display six or more symptoms for at least 6 months, and an adult must display five or more symptoms before a diagnosis is confirmed (Block, Macdonald, & Piotrowski, 2015; CDC, 2015a).
The many controversies surrounding the diagnosis and treatment of ADHD have made this developmental disability a household word. However, despite the debate about diagnosis, treatment, and unnecessary labeling of children, ADHD is recognized as a legitimate medical condition by the American Medical Association, the American Psychiatric Association, and several other major professional and health organizations.
The stigma that results from the many misconceptions that exist about ADHD and its treatment can affect both the children and adults who live with this condition as well as their families (Lebowitz, Rosenthal, & Ahn, 2016; Sarver, Rapport, Kofler, Raiker , & Friedman, 2015).
ADHD is a developmental condition of in-attention and distractibility, with or without hyperactivity, that manifests in three forms ( Soreff , 2017: Understood.org, 2017):
Inattentive a type of ADHD that is characterized by inability to attend to tasks, forgetfulness, and distraction.
Hyperactive/impulsive a type of ADHD that results in restlessness, impulsivity, and a lack of control Combined/other-a combination of the first two types
Although all three types are referred to as ADHD, it is important to note that hyperactivity is not present in all cases.
Heredity plays a role in ADHD, making individuals susceptible to certain environmental factors that are associated with the condition. These environmental risk factors include, but are not limited to, low birth weight, traumatic brain injury (TBI), and maternal smoking (National Institute of Mental Health (NIMH), 2016). ADHD is a common and growing problem.
Approximately 5% of children and adolescents and 4-5% of adults in the United States and 2.5% of adults worldwide are diagnosed with this disorder (CDC, 2017a; Faraone et al., 2015; WebMD, 2017). The number of children ever diagnosed with ADHD has been increasing at a rate of approximately 4% per year (CDC, 2017a).
Although boys outnumber girls by at least three to one in terms of the incidence of this disorder, recent research suggests that gender bias might have a role in over diagnosing boys ( Bruchmuller , Marrof , & Schneider, 2012: Snowman & McCown, 2015). Some children outgrow symptoms of ADHD, but many do not.
For example, a study by Miller, Ho, and Hinshaw (2012) found that impaired executive functions (ability to plan and organize, response inhibition, sustained attention, set shifting, working memory, and reasoning) in girls with ADHD were still present young adulthood.
ADHD in the adult population is estimated to be both underdiagnosed and undertreated and often exists with comorbid mental health and substance abuse disorders ( Antshel et al., 2011; Chen, 2016). Individuals with ADHD are often stigmatized, because ADHD is viewed by some as a behavioral disorder over which the individual should be able to assert control.
The poor academic and work performance often associated with ADHD further exacerbates the problem (Sherman, 2012). For these reasons, adults with ADHD may be unaware that they have the condition or be reticent to disclose this diagnosis (CDC, 2015a; Sherman, 2012).
ADHD affects individuals at all levels of intellect and is often compounded with other learning disabilities. The classic symptoms of inattention, hyperactivity, and impulsivity present numerous challenges for adults and children; as a result, people with ADHD often struggle in school and at work. Social issues are also present and can be significant. Individuals, particularly children and young adults with ADHD.
Often feel that they are different than their peers and may experience stigma that is self-imposed (McKeague, Hennessy, O'Driscoll, & Heary, 2015). Poor social skills exacerbate the problem and research has shown that children with ADHD have difficulty with friendships and peer interactions and are often bullied and victimized (Kok, Groen, Fuermaier , & Tucha , 2016).
Adults with ADHD are more likely to report being lonely than people without ADHD (Stickley. Koyanagi, Takahashi, Ruchkin, & Kamio, 2017). Often, medication therapy in combination with psychological interventions is the treatment of choice for both children and adults with ADHD.
Careful assessment is critical before working with anyone with ADHD. Nurses should have an open discussion with the patient, and with the parents if the patient is a child, to determine how he or she learns best. If the patient is unable to identify strategies that have worked well in school or work, the nurse must assess the patient's response to various techniques and make accommodations as necessary.
The nurse can then develop an individualized education plan (IEP) to promote learning through use of patient teaching strategies that compensate for or minimize the effect of the disability (Crandell et al., 2012; Greenberg, 1991, Hockenberry & Wilson, 2011). It is also important to remember, especially when working with adults or children who have symptoms of ADHD, that the patient may be undiagnosed or may choose to withhold this diagnosis.
Because ADHD is a condition that may persist into adulthood, a transition plan must be in place as the adolescent moves from pediatric to adult health care. Increasing autonomy in self-care and healthcare decision making is an important goal for adolescents with ADHD as they transfer into adult healthcare settings.
However, adolescents and their families are often fearful to leave their pediatric practitioner: and in fact, some individuals experience negative outcomes as they move to adult care practitioners who are unfamiliar with their needs. The American Academy of Family Physicians. and American College of Physicians have established guidelines, which are referred to as the Got Transition Model, for successfully stream-lining adolescents to adult health care.
This model has six core components that include the establishment of transition policies, tracking and monitoring progress, determining transition readiness, transition planning, transfer of care, and follow-up after transfer is complete (Inman, Scott, & Aleshire, 2017). The need for education for the youth and family is critical throughout the process.
Children and adults with ADHD have a wide range of needs that can be addressed through education. One area of importance relates to the misuse and/or diversion of stimulant medication often used to treat ADHD. This is a common problem, particularly among adolescents who may misuse the drug themselves. sell it, and/or give it to friends. Research has demonstrated that healthcare providers often neglect or fail to adequately address this important area for teaching (Colaneri, Keim, & Adesman , 2017).
Nurses should consider the following strategies when working with adults and children with ADHD:
Provide encouragement during teaching because they are likely to have experienced failure in school and work settings and may lack confidence in their abilities to manage their health care.
Focus on the positives rather than on the deficits. Research indicates that they have many of the same cognitive strengths as those without ADHD (Climie & Mastoras, 2015).
Consider the learning style of individuals. For visual learners, use colorful handouts and slides; for kinesthetic learners, incorporate movement and activity; and for auditory learners, have them read out loud and consider the use of a recorder so that teaching sessions can be replayed.
Because patients with ADHD may have difficulty maintaining appropriate attention levels, these strategies likely will attract and hold their attention. Break content to be taught into small, focused sessions whenever possible. If they have multiple care related tasks to accomplish on their own, teach them to break their care into smaller tasks.
Structure the environment to eliminate unnecessary distraction. Consider using stress reduction techniques prior to teaching to enhance learning in patients who may be anxious.
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