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ADHD Most Common Neurodevelopmental Disorder Attention-Deficit/Hyperactivity Disorder (ADHD) is now hailed as one of the most common neurodevelopmental disorders worldwide. The Centers for Disease Control estimates that up to 5% of children/adolescents and adults are diagnosed with ADHD. The long-standing debate on the over-diagnosis or overprescribing of ADHD medications continues. The DSM-5-TR is a medical classification system for mental illness published by the American Psychiatric Association. Attention-Deficit/Hyperactivity Disorder is defined in the DSM-5-TR as a "persistent pattern of inattention and hyperactivity-impulsivity that interferes with functioning or development." There are three types of ADHD detailed in the DMS-5-TR. What are the Three Types of ADHD? 1- Primarily Hyperactive and Impulsive ADHD Hyperactive and Impulsive ADHD often present with fidgeting, squirming, and an inability to stay still. Children may act like they are "driven by a motor" and move excessively. They may interrupt others when speaking, yell out, and struggle with self-control. Hyperactive symptoms include: Squirms and shuffles hands and feet Does not stay seated and gets up at inappropriate times Frequently cannot play or participate in other activities quietly Often "on the go" or acting as if "driven by a motor." Excessive talking Impulsive symptoms include: Often blurts out Has trouble waiting their turn Often interrupts or intrudes on others 2- Primarily Inattentive ADHD Inattentive ADHD may present with careless mistakes, difficulty following detailed instructions, and difficulty organizing tasks and activities. They may lose things quickly. Other symptoms include being easily distracted by external stimuli and weak working memory. Inattentive type ADHD is more commonly found in adults and girls. It was formerly known as ADD. Symptoms include: Not giving close attention to details and making careless mistakes Cannot maintain attention during activities Does not pay attention when spoken to directly Does not follow through with directions, finish work, chores, or duties at work Often has difficulty organizing tasks and activities Often dislikes tasks that require long periods of concentration Easily loses things and is often late Often easily distracted by stimulation outside of the current setting Often forgetful in daily activities 3- Combined Type ADHD This type of ADHD will have six or more symptoms of Inattentive Type ADHD AND six or more symptoms of Hyperactive and Impulsive ADHD. It's important to note that the DSM-5-TR requires that six or more of these symptoms be present for at least six months. The symptoms should be to the degree that they interfere with the person's developmental level and negatively impact social and academic activities. More than one symptom is present in more than one setting (home, school, work) Clear evidence must be present that the symptoms interfere with or reduce the quality of the school, social, or work functioning. The symptoms cannot be explained by another existing mental health disorder (mood disorder, anxiety disorder, substance intoxication, or withdrawal) There are several screening tools used to help healthcare providers diagnose ADHD. The most commonly used screening tool for adult ADHD is the World Health Organization (WHO) Adult ADHD Self-Report Scale. The NICHQ Vanderbilt Assessment Scales are widely used in pediatrics. There are multiple options for treating ADHD. Medication is the next treatment option if behavioral management alone fails. Non-pharmaceutical methods include behavioral management. Behavioral Management First-line treatment should be behavioral management by the parents and the teacher. It is most effective if the parents and teachers work closely together. If behavioral management is inadequate, medication is the subsequent treatment of choice. However, the CDC recommends that behavioral management be the first treatment choice due to the side effects of the medications used to treat ADHD. Some of the behavioral treatment strategies include positive reinforcement and time-out. Medication Stimulants The first option for pharmaceutical management of ADHD is often stimulants. These drugs are in a class called amphetamines. Amphetamines are central nervous system stimulants that work by increasing the amounts of dopamine, norepinephrine, and serotonin. Stimulants are some of the most common drugs used to treat ADHD. We are all familiar with Adderall and Ritalin. Recently, newer medications have been developed, such as Quillichew and Vyvanse. These drugs have the potential to become habit-forming. Like other drugs, they come in extended-release or short-acting. Non-stimulants One of the most common non-stimulant drugs prescribed for treating ADHD is atomoxetine (Stratterra). Stratterra is a selective norepinephrine reuptake inhibitor (SNRI). This type of drug is also beneficial for the treatment of depression and mood disorders. Two other drugs commonly used are antihypertensives called clonidine (Catapres) and guanfacine ( Tenex, Intuniv). These are both alpha 2-agonists and are typically used for hypertension. Doctors also use these drugs as an off-label treatment for ADHD. Homeopathic treatments Homeopathic remedies such as herbs and minerals are also being explored to treat ADHD. Brillia is one of the most common homeopathic treatments for adults and pediatric populations. The National Institute of Health (NIH) published information suggesting evidence of overdiagnosis and overtreatment of ADHD in children and teens. The NIH states that this could be due to the definition of ADHD being more inclusive of behaviors that would have been considered normal in previous years. In other words, some behaviors that used to be considered typical for young children have now been considered abnormal and are listed as symptoms. Thoughts from a School Nurse ... Attention-Deficit/Hyperactive Disorder is one of the most common chronic conditions I encounter as a school nurse. I administer medications to treat ADHD daily and have experience giving stimulants, non-stimulants, and homeopathic remedies. Being a nurse and seeing the habit-forming tendencies of stimulants raises my concern. Having students take amphetamines during the day and a sedative at night for sleep aid is also worrisome. These students are exposed to uppers and downers in a structured way. Thinking about how they will regulate themselves once the prescriptions stop is concerning. I have parents that have had older children use stimulants to treat their ADHD and have developed dependencies. They are reluctant to prescribe their younger children medication and sometimes opt for homeopathic options. In some instances, it is a necessary treatment to help children do their best academically. I have also witnessed children that have been born addicted to illegal substances. Ironically, the bulk of these cases are babies born addicted to methamphetamine. Because of that, behavioral and neurologic deficits keep them from being attentive and cooperative in the classroom. These students benefit from the treatment of stimulants and often can participate and learn with their classmates after starting a medication regimen. The cause of ADHD has been blamed on a plethora of cultural changes. Screen time and absent parents seem to contribute at least to some extent in most research. Although there are many contributing factors, the long-standing debate on over-prescription and over-medicating children still stands. Most research lacks a definitive answer. References/Resources ADDitudeMag.com: 1998 - 2023 WebMD LLC Overdiagnosis of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: National Center for Biotechnology Information: National Library of Medicine Common ADHD Medications & Treatments for Children: healthychildren.org: American Academy of Pediatrics HOMEOPATHIC PRODUCTS TO Reduce Hyperactivity, Impulsivity and Anxiety in Children, Teens & Adults: Brillia, Hadaf, LLC Attention Deficit Hyperactivity Disorder (ADHD): Centers for Disease Control and Prevention Table 7DSM-IV to DSM-5 Attention-Deficit/Hyperactivity Disorder Comparison: National Center for Biotechnology Information: National Library of Medicine
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I have never worked with peds outside of the school setting, but we have training on how to communicate with students we suspect are being abused and are expected to report immediately. Hopefully, spreading awareness and giving instructions on how and when to report will encourage others to advocate for these children!
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I'm sorry you lost your dad to this. Hopefully, screening techniques will continue to improve, and we, as nurses, can continue to educate the importance of catching it early. Happy to hear yours was caught in the precancerous stage. Although, losing a section of your colon is still difficult!
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April is National Child Abuse Prevention Month (NCAPM). It was established in 1983 to raise awareness and to help prevent abuse among our littlest. I must admit ... I grew up and lived in rural West Tennessee most of my life, and until I worked within the school system, I was unaware of the frequent occurrence of child abuse and neglect. My hat is off to you, Teachers. Frequently, they are the whistle-blowers. They know their students. They recognize when they have an "off" day, or something doesn't add up. Teachers are often trusted by students and are sources of comfort. They will often confide in them first. Before working in the schools, I worked MedSurg at my local hospital. I have witnessed elderly abuse and neglect. I have seen the devastation of drug and substance abuse on families and individuals. These are heartbreaking situations. When I began working as a school nurse, the stress-free environment and not carrying home the worry of how my patients were until my next shift appealed to me. No longer did I have to worry, " Did I do everything? Did I do enough? Should I have ... ?” This naïve bliss lasted about a month. When I had a young girl that wanted to come to see me multiple times a day, first, maybe her head would hurt, then a paper cut, and later, she may have a stomachache. Multiple visits throughout the day for multiple ailments became the norm. She was trying to develop a connection and, maybe for the first time, felt cared for. One day she trusted me enough to say it. She told me about the abuse she had received at the hands of her mom's boyfriend. Such a heavy weight to bear for such a tiny person. That's the case for so many of our little ones. Tiny humans, tiny hearts, little souls walking around carrying adult-size burdens. So, in honor of the littlest among us who stay brave and wake up and endure and survive, we raise awareness. Every child deserves a safe home. How Can You Help? In Tennessee, everyone is required by state law to report knowledge or suspicions of child abuse or neglect. Tennessee state laws protect persons who report suspicions of abuse or neglect in good faith. The reporters always have the right to remain anonymous. The Tennessee child abuse hotline is 1-877-237-0004. What are Common Signs of Abuse In Children? Poor hygiene Being dressed inappropriately for the weather Failure to thrive, poor weight gain, malnutrition 6-20% of abused children will have burns: cigarette, rope, immersion (hot water), or shape of the hot object Unexplained bruising, fractures, abrasions Bedwetting, nightmares, trouble sleeping Research shows that children suffering from the stress of abuse and neglect are more likely to struggle in their behavioral, physical, and cognitive abilities. The most devastating fact about child abuse is that it often becomes generational. That is why raising awareness and stopping the cycle of abuse are so important. What is the Good News? The National Institute of Health (NIH) reports declining sexual and physical abuse. Self-reported school data has shown a 28 % reduction in sexual abuse and a 20% reduction in physical abuse. This is attributed to the prevention programs in schools and the criminal justice system becoming more involved in child abuse and domestic violence. Centers in West TN, like the Exchange Club Carl Perkins Center of Lauderdale County, make a difference daily in their community. Organizations like these strive to give each child hope for a bright future. Consider joining in the efforts against child abuse by volunteering at your local child abuse prevention organization.
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March is colorectal awareness month. Now more than ever, awareness is key to slowing this disease. Colorectal cancer climbed to be the second leading cause of cancer deaths in the United States. The rate of colorectal cancer has been steadily on the rise since the 1990s. To raise the attention of colorectal cancer, President Clinton declared March as National Colorectal Cancer Awareness Month in 2000. This trend is not unique to the United States. Canada, New Zealand, Australia, and some parts of Europe and Asia have also been experiencing this trend. In 2020, the National Cancer Institute and the National Institute of Environmental Health Sciences (NIEHS) brought 400 leading scientists together to begin a dialogue about the possible causes of this trend. Scientists have not determined a specific cause for the increase in young adults. They do stress the importance of spreading awareness. What is Colorectal Cancer? Colorectal cancer is cancer that begins in the colon or rectum. The colon has three primary functions: absorbing water, producing and absorbing vitamins, and moving feces toward the rectum. The rectum stores stool until the body has a bowel movement. According to the Colorectal Cancer Alliance, most colorectal cancers start as polyps. A colon polyp is a small group of cells forming on the colon's lining. Polyps are common and usually harmless. However, over time some polyps may become cancerous. What are the Symptoms of Colorectal Cancer? One of the most dangerous traits of colorectal cancer is that it may not cause symptoms. When symptoms do occur, they may include: Unexplained weight loss If a person is not trying to lose weight and experiences a noticeable drop in weight, it should always be followed up with their doctor or primary care. Unintentional weight loss of more than 5 percent of your weight over 6-12 months warrants a visit to your healthcare provider. Weakness and/or fatigue Most people can tell when their fatigue is unusual. If your fatigue feels like something more serious or lasts longer than a week or two, it may be time to see your healthcare provider. Abdominal discomfort Abdominal discomforts such as cramps, gas, or pain and feeling as though your bowel does not empty should be discussed with your doctor. Change in bowel habits A change in the consistency of stool, alternating between constipation and diarrhea or stools that become more narrow Rectal bleeding Bright red blood is sometimes noted. Blood in the stool can make the stool look darker, causing the stool to appear black or tarry What are the risk factors? Risk Factors include: Age 90% of colorectal cancer diagnoses occur in patients over the age of 50; although there has been an alarming increase in young adults ages 20-34 Conditions such as Irritable bowel disease (IBD), which includes conditions like Crohn's disease and ulcerative colitis, increases the chances of colorectal cancer diagnosis Lifestyle Obesity, smoking, being inactive, and a diet high in red meat, fried foods Family History 2 or more first-degree relatives or 1 first-degree relative before the age of 60 Race Incidence is highest among African Americans Eating a diet high in fiber, exercising, limiting alcohol consumption, and avoiding tobacco may reduce their risk of developing colorectal cancer. Early detection and treatment can increase the survival rate. Regular screening at age 45 is key to finding it early. The gold standard is a colonoscopy. It only needs to be done every ten years for ages 45-75. Your doctor may recommend early screening if you have risk factors and a family history of colorectal cancer. What's the Good News? The death rate for colorectal cancer has been dropping over the last 30 years. Screening and improved treatments have helped lower the death rate. Let's continue to raise awareness for this preventable and treatable disease! References/Resources Colorectal Cancer Awareness Month: The American Society of Colon and Rectal Surgeons (ASCRS)