Attention Deficit Hyperactivity Disorder ADHD Nursing Care Plans Diagnosis and Interventions
ADHD NCLEX Review and Nursing Care Plans
ADHD Attention Deficit Hyperactivity Disorder is a behavior disorder in the brain wherein the person has trouble paying attention and concentrating. It is the most common mental disorder diagnosed in children, and can also be seen in adolescents.
ADHD can continue into adulthood as it cannot be cured. However, people with ADHD can cope and manage symptoms with proper education and good compliance to treatment and therapy.
Signs and Symptoms of ADHD
The signs and symptoms of ADHD are usually recognizable before the age of 6. The symptoms emerge not just in one setting such as either home or school, but can manifest anytime, anywhere. The general signs and symptoms of ADHD include:
- Inability to pay attention or short attention span
- Inability to concentrate on doing tasks
- Inability to carry out instructions
- Inability to sit still
Once the child with ADHD turns into an adult, the following symptoms may also be noted:
- Frequent lateness
- Low self-esteem
- Work or relationship problems
- Easily bored and/or frustrated
- Substance addiction
- Inability to control anger or other strong emotions
- Mood swings
Types of ADHD
There are 3 types of ADHD and each has some distinct features. These include:
- Inattentive. Aside from the general ADHD symptoms, child with an inattentive type of ADHD can be observed to have the following signs and symptoms:
- Easily distracted
- Trouble organizing daily tasks
- Dislikes activities that require sitting still such as being in class and listening to the teacher
- Doesn’t appear to be actively listening
- Often daydreams
- Often loses things
2. Hyperactive-Impulsive. In this type of ADHD, the child may exhibit the following signs and symptoms:
- Fidgeting, bouncing, or squirming while sitting
- Talking excessively
- Appears very energetic and “always on the go”
- Interrupts other people when they are talking or doing something
- Blurts out answers as soon as he/she is asked a question
- Finds it hard to wait for his/her turn
- Restlessness – always running around, climbing, jumping, or moving things unnecessarily
3. Combined. This type of ADHD features both the signs and symptoms of inattentive and hyperactive-impulsive types of ADHD.
Causes and Risk Factors of ADHD
The root cause of ADHD is still unknown. However, the following risk factors are related to ADHD, such as:
- Genetics – there is a tendency for ADHD to be passed to the next generations in a family
- Brain structure– research shows that children with ADHD has smaller frontal lobes than children who do not have this condition
- Brain chemistry – the neurotransmitter dopamine is not properly regulated by the central nervous system
- Toxins – toxic substances such as lead may affect the development of a fetus inside the womb, or a child while he/she is growing up; some research shows evidence of the maternal diet having an effect in modulating symptoms of ADHD in a fetus
- Brain disorder or injury – brain damage may lead to trouble controlling emotions, mood, thoughts, and impulses
- Pregnancy-related issues – smoking, substance abuse, drinking, poor nutrition or infections during pregnancy may affect the development of baby’s brain.
Contrary to common belief, sugar, stress, food allergies, or watching too much TV/ using gadgets excessively do not cause or trigger ADHD.
Complications of ADHD
- Accidents and injuries
- Substance abuse
- Overweight or obesity
- Eating disorders
- Sleep problems
- Delinquent or risky behavior
- Poor self-esteem
- Trouble interacting with family, friends, and peers
- Relationship difficulties
Diagnosis of ADHD
- Medical and social history of the child and family – to check for any genetic involvement, pregnancy issues, social problems, presence of any brain injury or disorder, exposure to chemicals and toxins, etc.
- Physical exam – includes neurological assessment of the senses, motor, and verbal skills
- Cognitive tests – to check for aptitude, intelligence, processing skills, or personality traits
- Neuropsychiatric EEG-Based Assessment Aid (NEBA) System – to measure the beta and theta waves in the brain; the ratio of these two waves can help determine ADHD in children and teens
Treatment for ADHD
Currently there is no cure for ADHD; however, there are many approaches to manage the symptoms of ADHD that can allow the child to live a normal life as much as possible. These include:
- Medications. Stimulants are prescribed to control the impulsive and/or hyperactive thinking and behavior in children with ADHD. Taking stimulants may promote a longer attention span and help the child think about his/her actions before doing them. In some cases of ADHD, non-stimulant medications are more beneficial. These non-stimulants include the use of anti-depressants. It is important to note that ADHD drugs may cause several side effects, such as gastrointestinal upset, fatigue, loss of appetite, headache and anxiety. Omega-3 containing supplements may also provide some benefit for ADHD clients.
- Therapy. The following therapies may help a patient with ADHD:
- Cognitive behavioral therapy (CBT) – this can effectively facilitate behavior modification so the child with ADHD may be able to function properly in the society. Through CBT, “good” behaviors can be nurtured, while the bad ones can be pruned out or modified.
- Social skills sessions – these sessions can help to train a child with ADHD on how to talk, behave, and act around other people.
- Psychotherapy – also known as counselling, psychotherapy can help an ADHD patient to explore repressed feelings and thoughts. It is also effective in exercising relaxation techniques and encouraging compliance to treatment and therapy sessions. The family and significant others of the patient should be encouraged to undergo counseling as needed.
- Support groups – involving an ADHD client in a group of people who also have ADHD or have family members who has the condition can help the patient cope with it by listening to others and also by speaking about his/her own experience with ADHD.
3. Lifestyle Changes. Getting enough sleep and exercise, lessening distractions in the child’s room, and eating a healthy and balanced diet can help manage the symptoms of ADHD.
Nursing Diagnosis for ADHD
ADHD Nursing Care Plan 1
Nursing Diagnosis: Disturbed Thought Process related to dopamine imbalance secondary to ADHD as evidenced by forgetfulness, inability to concentrate and pay attention, inability to do tasks as instructed, blurting of words, poor decision-making skills, and difficulty handling complex tasks
Desired Outcome: The child will perform activities of daily living as he is able to do, while being able to vent out feelings of frustration and being able to retain memory through memory techniques.
|Nursing Interventions ADHD||Rationales|
|Assess the child’s current level of functioning and approach him/her through his/her “mental” age and not the chronological age.||To encourage the child to speak up, and to be open and honest about what he/she thinks and feels.|
|Assist the patient while performing activities of daily living.||To promote autonomy by allowing the patient to perform their ADLs while maintaining safety.|
|Simplify tasks for the child by using simple words and instructions Use written notes and other memory devices when necessary.||A child with ADHD may have difficulty handling complex tasks and may also tend to be forgetful.|
|Provide opportunities for the patient to have meaningful social interaction.||To prevent feelings of isolation.|
|Allow the patient to take time and think about what to say or do.||To help the patient have enough time to communication as he/she can be forgetful and also unable to make fast decisions.|
|Provide gentle instructions to the patient using a step-by-step method. For example: When bathing: “damp your face first using a washcloth, lather soap on hands and gently apply on the face.”||ADHD features a low level of concentration, so breaking down tasks into simple steps can help organize thoughts and actions.|
|Ensure that the patient takes medications on time and as prescribed. Encourage the child and parent to attend therapy sessions religiously.||To ensure adherence to medical and therapy regimen.|
ADHD Nursing Care Plan 2
Nursing Diagnosis: Impaired Social Interaction related to hyperactivity secondary to ADHD as evidenced by restlessness, inability to listen, verbalization of low self-esteem, conflict with parents and other people, talking excessively, anxiety, blurting words, and tendency to interrupt other people when they are talking or doing something
Desired Outcome: The patient will demonstrate improved social interaction by increased participation in social events.
|ADHD Nursing Interventions||Rationales|
|Explore the patient’s thoughts and feelings about relationship with family and other people, without judging or giving suggestions at first. Assess the anxiety level of the patient, anxiety triggers and symptoms by asking open-ended questions.||To establish a baseline observation of the anxiety level of the patient. Open-ended questions can help explore the thoughts and feelings of the patient regarding social isolation.|
|In the beginning of the talking therapy, allow the patient to continue ADHD behavior without any judgment or verbalization of disapproval.||The child may become more relaxed and open for discussion if he/she is allowed to precipitate the heightened anxiety by continuing ADHD-related behaviors.|
|Initially, support the patient by meeting dependency needs if deemed necessary.||The patient can become more anxious if the avenues for dependency are suddenly and/or complete eliminated.|
|Encourage the patient to be independent and provide positive reinforcement for being able to do self-care and other independent behaviors.||To enhance the patient’s self-esteem and encourage him/her to repeat desired behaviors.|
|Discuss with the patient and significant other/s the available treatments for anxiety.||Psychotherapy involves speaking with a licensed therapist and going through how to gradually cope with the symptoms. Medications such as anxiolytics and antidepressants can help the patient cope with the symptoms of ADHD.|
|Provide a supportive approach when gradually teaching the child simple social skills such as active listening and letting others have enough time to speak.||To promote better social interaction between the child and other people.|
|Encourage him/her to join social events. Include his/her interests/previous hobbies in the activities of the social group.||To provide chances for the patient to interact socially.|
|Encourage the patient to perform activities like crafts and games with one or more persons during the day and discourage sleeping during the day.||Sleeping during the day can make the patient less sleepy at night, which can cause insomnia. Encouraging socialization can help the patient cope with the symptoms and complications of ADHD.|
|Teach the patient to perform relaxation techniques such as deep breathing exercises, guided imagery, meditation, and progressive muscle relaxation.||To promote relaxation and reduce stress levels.|
ADHD Nursing Care Plan 3
Nursing Diagnosis: Risk for Delayed Growth And Development related to mental illness (hyperactivity) secondary to ADHD.
- The patient will demonstrate age-appropriate behavior.
- The patient will exhibit developmental progress.
|ADHD Nursing Interventions||Rationale|
|Obtain information on the patient’s condition and developmental stage from different sources, such as the patient’s caregivers, family members, colleagues, and teachers. Ask questions such as, “How did he/she interact with others (classmates, siblings, relatives)?” and “How did they perform academically?”||ADHD is associated with temperamental differences, resulting in unique behavioral styles and patterns, frequently compromising physiological function. The child is likely to experience irritability, restlessness, and sleep disruptions, all of which can retard growth and development (learning).|
|Obtain family history and note patterns of ADHD or related comorbidities within the family.||This offers insight into the patient’s childhood and adolescence.|
|Interview the patient and assess for present medical conditions that may overlap with ADHD symptoms.||Depression, anxiety, bipolar disorder, and personality disorders are conditions that may coexist with or mirror the symptoms of ADHD. As a result, the patient may be misdiagnosed and receive inappropriate treatment.|
|Inspect for the presence of vision and hearing deficits. Note any signs of neurodevelopmental deficits, such as vocal tics, poor fine motor control, and poor hand-eye coordination.||Not all ADHD patients may exhibit symptoms of learning disorders (LD). Poor academic performance associated with symptoms of neurodevelopmental immaturity may be confused with ADHD.|
|Obtain growth measurements by having the patient describe the rate and age of peak height.||Drugs (e.g., stimulants) targeted to alleviate ADHD have been linked to growth suppression among pediatric patients.|
|Approach the patient according to his or her current level of functioning. Avoid using baby talk and identifying them by their chronological age. Encourage emotional expression and provide therapeutic responses.||Promotes intellectual conversation. Emphasizes that the patient is a real person capable of independent thought.|
|Encourage the patient’s significant other or partner to participate in the assessment phase.||When providing a medical history, the patient may have trouble recalling and providing an accurate time frame of specific instances in which changes started appearing. He/she may also not fully recognize the extent of his/her clinical signs and symptoms. Patients may benefit from the presence of a trusted companion or family member when discussing their condition since they offer a more complete and accurate depiction of the patient’s past and current functioning.|
|Offer opportunities for a private conversation.||There are certain life experiences that the patient may be unwilling to discuss with his or her partner. For comparable reasons, the other person may also be granted individual privacy throughout the interview regarding issues they may feel uncomfortable discussing in front of the patient.|
|Employ memory retention strategies such as writing a list of activities or chores, providing a timetable, memory cue games, and mnemonic devices (e.g., imagery, acronyms)||Helps the patient remember information and strengthens working memory.|
|Provide activities according to age.||There are activities that may not be applicable to all age groups.|
|Schedule activities strategically and emphasize the importance of pacing the patient’s activity levels.||Patients with ADHD have poor self-regulation. The most demanding tasks should be performed in the morning when the patient is more focused and productive. Poor control of activity makes it harder to participate and increases the risk of making impulsive decisions.|
|Utilize a reward system to provide positive reinforcement. Explain the effects of negative reinforcement (punishment) to parents or caregivers.||Every successful attempt to complete a task, goal, or intervention should be acknowledged with a simple gesture, a star, a smile, or even positive remarks such as: “You did fantastically,” “You are brilliant,” and “I am glad to see you are learning to care for yourself and be independent.” These measures help the patient learn and develop new abilities that are appropriate for his or her age and developmental stage.|
|Refer to a guidance clinic and administer medications as prescribed||Facilitates developmental process and rapid motor improvement|
ADHD Nursing Care Plan 4
Nursing Diagnosis: Compromised Family Coping related to disruptive or intrusive behavior with parents or siblings secondary to ADHD, as evidenced by expressed concern and fear by the family regarding the patient’s status, disproportionate protective behavior, anxiety, and decreased patient contact.
- The family will be able to express their thoughts and feelings, find resources to help them deal with the situation, and address the patient’s needs.
- The family will adopt effective coping strategies.
|ADHD Nursing Interventions||Rationale|
|Assess the patient’s temperamental and behavioral characteristics.||Identifies persisting patterns of psychological maladjustment. It allows health providers to identify conditioning and periods of calm and active sleep to arrange supportive care for the patient and his or her family.|
|Assess the family’s current coping status and level of understanding regarding the patient’s disease and its associated clinical manifestations, such as attention-seeking behaviors and hyperactivity.||This evaluation will help the family receive the necessary support and assistance.|
|Assess family functioning, coping, and adaptability.||Measures the ability of the family system to change its structure, role, and function to the change in the health status of the patient. This assessment also assesses direct attempts to deal with the situation and pain and use active methods (e.g., information seeking, positive self-statements) to disengage from stressors and ineffective coping.|
|Examine the probable sources of ineffective coping behaviors (e.g., depression, violence). Refer to a psychiatric clinical nurse specialist, support group, or case manager as appropriate.||Identifies situational factors to facilitate understanding of the patient and the family’s current situation. An important step in making positive behavioral changes is to become aware of one’s own destructive coping mechanisms. Assessing guarding behavior may necessitate asking the patient questions such as “Would you like to discuss your thoughts and concerns with me?”.|
|Determine the level of fatigue and use of avoidance coping by the family or parents.||These effects have been associated with the patient’s health status. Although avoidance coping offers temporary relief, it also puts strain and stress since the problem hasn’t been dealt with effectively. Family members (parents, siblings) who have difficulty regulating their emotions and rely on catastrophic thinking as a coping mechanism may have difficulty motivating and supporting the patient to maintain and continue daily activities.|
|Evaluate the family’s prior use of coping strategies.||Previous coping strategies may be a helpful indicator of how a person will cope with a situation in the future; however, if present coping strategies are inadequate, it may be necessary to learn new coping skills.|
|Provide factual information regarding the patient’s health condition, temperament, and prognosis, including its management and therapy, and allow ample opportunity for questions.||When a patient’s family does not have a clear understanding of the condition, they may not be capable or competent in supporting the patient in their efforts to learn new skills and adjust to their condition. Knowledge will increase the family’s understanding of ADHD and related behavioral issues. In addition, it aids in the development of coping skills and strategies.|
|Involve family members in the planning process and enable them to collaborate with the primary care team to develop an individualized care plan.||A supportive environment improves the patient’s and family’s coping abilities.|
|Provide family members opportunities and space for discussions. Enable them to vent concerns and problems and respond to them therapeutically.||Enables the nurse to clarify the family’s perspective and feelings regarding the temporary disorganization, role changes, and the failure to give reciprocal support brought about by the progression of the patient’s disability or condition. This also provides opportunities to clarify misconceptions and misinformation concerning ADHD.|
|Assist the family in constructive problem-solving and reinforce newly learned skills such as interpersonal, coping, parenting, social, and decision-making skills.||These skills help the family gain knowledge and techniques to adequately deal with the conflict and the situation. Family members should be aware of appropriate techniques and employ them successfully to assist the patient in accomplishing difficult tasks.|
|Alter the care environment by dimming the lights and reducing the noise level.||Decreases maladaptive behaviors (e.g., disorganization, inability to focus, easily distracted).|
|Assist the family in learning and acknowledging the patient’s nonverbal communication cues and interpreting them appropriately||Promotes the development of healthy parenting skills and practices|
ADHD Nursing Care Plan 5
Risk For Violence: Self-Directed or Other Directed Violence
Nursing Diagnosis: Risk For Violence: Self-Directed or Other Directed Violence related to impulsivity secondary to ADHD.
- The patient will gain emotional control and refrain from agitating others.
- The patient will show no signs of abusive behavior and will promptly seek help in the event of an impending emotional crisis.
|ADHD Nursing Interventions||Rationale|
|Assess the patient’s behavior and observe for reactive patterns such as increased agitation and hyperactivity.||ADHD patients usually express anger in the form of physical aggression or hostility, whether to self, others, or property. These effects have been linked to cognitive declines and impaired communication, which renders ADHD patient’s incompetent to regulate emotions, maintain social interaction, and engage in constructive problem-solving.|
|Routinely monitor the patient’s behavior during activities and interactions.||Patients at risk for violence require close supervision. Early detection of escalating agitation and hyperexcitability allows for prompt intervention that will help prevent the risk of self-harm or to others.|
|Ensure that the patient is receiving adequate sleep and rest||Patients may pace and become easily irritable due to sleep disturbances.|
|Educate the parents or significant others to recognize the symptoms of impending aggression and loss of control. Avoid using an accusatory tone when discussing with the patient.||Phrases such as “You’re getting a little too excited or restless” in specific situations will help label or identify the exact maladaptive behavior the patient is exhibiting. They may understand what their action meant and be compelled to take a breath, find space, or withdraw (time out). The parents/significant others should explain and talk about what happened and clarify why the patient’s behavior was labeled as overexcited.|
|Set realistic expectations and provide the patient with a structured environment||Patients may act in terms of unrealistic expectations. For instance, the patient, after diagnosis and management of LD and ADHD, would expect an immediate improvement in their academic performance with those within their age bracket. If the nurse fails to inform the patient of the prognosis and reality of his or her situation, the patient is at risk for self-directed violence.|
|Maintain a neutral demeanor and avoid arguing with the patient.||Verbal tantrums are typical reactions seen in ADHD patients. During a tantrum, the patient may criticize and blame others, ignore requests, and deny support or accountability. They may also become defensive and evoke insignificant matters that are intended to provoke negative responses and bother others. The nurse and caregivers should never dispute with the patient to avoid power struggles and aggravation of defiance.|
|Shift the patient’s focus upon signs of agitation. Redirect the patient when potentially violent or dangerous conduct occurs.||This measure relieves pent-up emotions, unreleased hostility, and muscle tension.|
|Employ effective communication strategies, such as keeping a neutral tone and making deliberate, consensual physical contact (holding their shoulders) to gain the patient’s attention. Answer questions truthfully.||This measure helps ADHD patients lessen their sense of isolation and recognize their individual challenges.|
|Provide structured diversional activities and low-stimulating physical outlets.||ADHD is characterized by disorganized thoughts and trouble focusing. The patient’s short attention span can make it difficult for him or her to remain engaged; therefore, the provision of appropriate diversional activities helps minimize feelings of boredom and lack of motivation.|
|Eliminate all harmful objects within the patient’s care environment.||Hyperactivity can result in destructive behaviors that may cause harm to oneself or others.|
|Administer tranquilizers upon order by the physician.||Provides relief from immobilizing effects of ADHD and anxiety disorders. It is also indicated as a monotherapy for hyperactivity.|
|Chart and document the patient’s behaviors, treatments, responses, possible agitation, prescriptions, and soothing measures as needed.||Helps staff recognize potential escalation of aggression, mania, and self-destructive impulsive behavior.|
|Recommend behavioral therapy upon symptoms of emotional dysregulation.||Self-regulation is impaired in ADHD patients. Conditions such as irritable depression and oppositional defiant disorder can prolong a patient’s mood and result in angry outbursts, a combative stance, spiteful reactions, and aggressive defiance. These behavioral issues are treatable with medication and behavioral therapy.|
More ADHD Nursing Diagnosis
- Risk for Injury related to hyperactivity and impulsiveness secondary to ADHD
- Risk for Parental Role Conflict
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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