Attention-Deficit Hyperactivity Disorder (ADHD) Essay

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Attention-Deficit Hyperactivity Disorder (ADHD) Essay

ADHD in adults Problem: 6.2 million adults in USA have ADHD but approximately 75% are undiagnosed. Data does not exist to specify local rates of ADHD in adults in Cypress, TX. Background: undiagnosed and untreated ADHD is associated with increased risk of poor school performance, job performance, relationship problems, & increased risk for motor vehicle accidents, specifically collisions. Data collection: standardized validated diagnostic screening forms Adult ADHD Self-Report Scale Symptom Checklist (ASRS) will be administered to a convenience sample of persons 18 y/o or older in the town of Cypress, TX. Diagnosis: screening results will be tabulated and compared against national statistics Implementation: persons screening positive on ASRS will be referred to psychiatry clinic in the community for further evaluation to determine if diagnosis of ADHD is present. Group education classes will be conducted and all persons screening positive will be offered this education class. Evaluation: Data collected, including number of persons screening positive for ADHD with ASRS, and number of persons receiving diagnosis of ADHD will be compared against national statistics to identify if local rates are greater than, equal to, or less than national statistics. Data can be further broken down and analyzed to evaluate trends based on individual demographics. Attention-Deficit Hyperactivity Disorder (ADHD) Essay.

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Attention-Deficit Hyperactivity Disorder (ADHD): Undiagnosed Adult in Cypress, Texas

Attention-deficit hyperactivity disorder (ADHD) is a neuropsychiatric/ neurodevelopmental mental disorder that typically commences in childhood. It usually subsides with treatment as the child approaches adulthood in most cases. However, in some cases, the condition progresses to adulthood with quite a negative impact on the social and occupational life of the victim. Because of this profile, the disorder affects children more, but it equally affects adolescents and adults too (NIH, 2017). Diminished sustained attention or inattention and hyperactivity/ excessive impulsivity are the hallmarks of this neurodevelopmental disorder. There is a quick loss of concentration when doing a task. This is also accompanied by forgetfulness. In children, there is marked academic impairment. But adult ADHD victims also experience problems forming lasting interpersonal relationships as well as integrating socially in the society. A combination of these factors therefore ends up affecting the work life of the adult with ADHD. The condition can present in three forms referred to as specifiers: predominantly inattentive presentation, predominantly hyperactive/ impulsive presentation, or combined presentation. According to Sadock et al. (2015), 85% of children who have ADHD continue to have it through adolescence and 60% continue having the condition as adults (Sadock et al., 2015; APA, 2013). This shows that a significant number of adults actually suffer from ADHD, yet the condition remains largely underdiagnosed in the adult population. Attention-Deficit Hyperactivity Disorder (ADHD) Essay. This paper discusses the behavioral disorder that is ADHD in adults (taking the city of Cypress in Texas as a microcosm), advanced public health nursing assessment and prevention, as well as scope of standard of practice on adult mental health by the advanced public health nurse.

Data on Adult ADHD in Cypress, Texas

There is a glaring paucity of literature on the data for adult ADHD in the city of Cypress in the state of Texas. For this reason, national data and data from the Centers for Disease Prevention and Control (CDC) will be used to extrapolate the likely scenario prevailing in the city of Cypress. Despite this lack of easily available data, however, the city of Cypress appears to be well resourced with psychiatrists, psychologists, and psychiatric-mental health nurse practitioners (PMHNPs), and therapists who offer treatment ad therapy for adult ADHD (Psychology Today, 2020a; Psychology Today, 2020b). By extrapolation, this abundance of supply in Cypress can be interpreted to mean that there is considerable demand for the services. What this means is that prevalence of adult ADHD in Cypress could be nearing the national average.

According to the National Institute of Mental Health (NIH), in the US adult population aged between 18 years and 44 years the lifetime prevalence of ADHD is about 8.1%. The current adult prevalence is however 4.4% with males being more affected (5.4%) compared to females (3.2%). An important observation to note in these statistics by NIH is that compared to all other racial or ethnic populations, non-Hispanic whites have a higher prevalence of adult ADHD. These statistics are based on data obtained from the National Comorbidity Survey Replication or NCS-R (NIH, 2017). By extrapolating these figures to Cypress, therefore, it can be surmised that the prevalence of adult ADHD in the city is 4.4%.

Underdiagnosis

About 2.5% to 5% of all adults suffer from ADHD. Surprisingly, approximately 75% of these remain undiagnosed. This scenario applies to the city of Cypress in Texas as it does to the rest of the United States. One reason for this situation is that ADHD is often comorbid with other conditions in adults, thereby masking its presentation. Data rom national statistics shows that between 17% and 22% of adults who are seen in psychiatric outpatient clinics for other mental health conditions also suffer from this behavioral disorder. The ADHD symptoms for these adult patients are however usually mistaken for those of the comorbidities they suffer from (Grinsberg et al., 2014). According to Leahy (2018), some of these comorbidities with adult ADHD include anxiety disorders, sleep disorders, and mood disorders. Underdiagnosis of adult ADHD has been found to be very rampant, contrary to the earlier belief that the condition subsided as a child grew into an adult. This has led to many adults having problems and obstacles in their lives without knowing or realizing that the cause is actually undiagnosed ADHD. It is not only their self-esteem that is affected but also their interpersonal relationships as well as their emotional wellbeing. Examples of the characteristics that may give away an adult suffering from undiagnosed ADHD are emotional marital problems and a lack of empathy while relating to others. The person may also suffer financial ruin as a result of impulsivity as in buying things without planning for the same. Additionally, the adult with undiagnosed ADHD may also find that they cannot concentrate in one job or keep it for long (Fast Braiin, 2018). Attention-Deficit Hyperactivity Disorder (ADHD) Essay.

DSM-5 Diagnostic Criteria for ADHD

There has been some criticism that one of the reasons for the underdiagnosis of ADHD in adults is that its diagnostic criteria in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) favor children. The DSM-5 diagnostic criteria are as follows:

  • (1) Inattention with six or more accompanying symptoms, (2) hyperactivity and impulsivity with six or more other accompanying symptoms
  • B: Presence of some symptoms of inattention or hyperactivity-impulsivity before the age of 12 years
  • C: Presence of some inattention or hyperactivity-impulsivity symptoms in two or more settings such as at work or school
  • D: Evidence that the symptoms are interfering with the individual’s functioning academically, socially, or at work
  • E: The individual’s symptoms cannot be explained by another mental disorder (APA, 2013).

Advanced Public Health Nursing Assessment, Prevention Programs and Interventions for Adult ADHD

The Advanced Public Health Nurse (APHN-BC) is a healthcare professional that analyzes trends in disease in the general population and then comes up with measures and interventions aimed at preventing the occurrence of the disease or condition. The advanced public health nurse is therefore primarily concerned with primary prevention of disease through education and health promotion. But in order to come up with educational and prevention strategies for a particular condition such as adult ADHD, the APHN-BC must first perform an assessment that will precede the implementation of interventions. This assessment by the APHN-BC is what will support the decision making on interventions for the population/ public. It generates information about the community/ population for which the public health nurse wants to come up with prevention strategies. To accomplish this assessment task with regard to adult ADHD, the APHN-BC uses the public health nursing assessment tool or PHNAT in which she will (Truglio-Londrigan, & Lewenson, 2016):

  • Assess the general health status of the population in Cypress in terms of morbidity, mortality, life expectancy, physically and mentally unhealthy habits amongst other factors.
  • Assess the quality of life and wellbeing of the population in Cypress. Attention-Deficit Hyperactivity Disorder (ADHD) Essay.
  • Assess the role of the social determinants of health on adult ADHD in Cypress. These will include housing conditions, recreational facilities, environmental sanitation, educational facilities, social services, and family income amongst others.
  • Assess for biology and genetics in the population of Cypress with regard to ADHD etiology. This is because about 75% of the etiology of ADHD is genetic (Sadock et al., 2015).
  • Assess for the availability of health services in the community of Cypress. This will be in terms of primary care and mental health services amongst others.
  • Assess the level of access to healthcare for the population in Cypress.
  • Assess the health policies and policy making in Cypress.
  • Assess the population behavior with regard to participation in disease prevention programs such as weight loss programs.
  • Perform a health disparities assessment.

Prevention Programs and Interventions for Adult ADHD in Cypress, Texas

It is not possible to completely prevent the emergence or manifestation of ADHD in adults. However, the preventive measures and interventions implemented by the APHN-BC can result in a reduction of the incidence of the condition in the general population, including that of Cypress. Some of the prevention programs and interventions the APHN-BC can implement in the case of Cypress include:

  1. Educating potential and expectant mothers on the benefits of avoiding smoking, alcohol, and substance use during pregnancy. This is because these have been found to be risk factors for ADHD in children. And as has been observed in the discussion so far, 60% of adult ADHD started in childhood.
  2. Avoiding or reducing environmental toxins and pollutants such as mercury and lead
  • Making important lifestyle changes in terms of having a consistent routine with exercise, healthy diet, and sleep.
  1. Encouraging early treatment of ADHD in childhood as this lessens its impact in adulthood.

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Advanced Public Health Nursing: Scope and Standards of Practice for Adult Mental Health

Like all advanced practice nurses, the APHN-BC is expected to be able to practice to the fullest extent of their education and training. Their unit of care is the entire population as opposed to individual patients. Their scope of practice includes:

  • To assess populations, diagnose their mental health problems, plan for primary prevention strategies, implement the population mental health prevention strategies, and evaluate the success of the prevention strategies in the population.
  • Educate the population on healthy environmental and social conditions that prevent the development of mental health problems.
  • Collaboration with various stakeholders, other healthcare professionals, the population, and various organizations in the promotion and protection of the mental health of the population (ANA, 2013; Washington State Nurses Association, 2011) Attention-Deficit Hyperactivity Disorder (ADHD) Essay.

Conclusion

The prevalence of adult ADHD is quite high despite the fact that the condition is grossly underdiagnosed in adults. Part of the reason is that ADHD is mostly comorbid with other similarly presenting conditions such as mood disorders and anxiety disorders. The role of the APHN-BC in preventing ADHD (lowering the incidence) is important because they are concerned with primary prevention of disease in entire populations, including mental health conditions.

References

American Nurses Association [ANA] (2013). Public health nursing: Scope and standards of practice, 2nd ed. Author.

American Psychological Association [APA] (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th ed. Author.

Fast Braiin (March 31, 2018). Understanding how to recognize underdiagnosed ADHD in adults. https://fastbraiin.com/undiagnosed-adhd-in-adults/

Grinsberg, Y., Quintero, J., Anand, E., Casillas, M., & Upadhyaya, H.P. (2014). Underdiagnosis of attention-deficit/ hyperactivity disorder in adult patients: A review of the literature. The Primary Care Companion for CNS Disorders, 16(3). https://doi.org/10.4088/PCC.13r01600

Leahy, L.G. (2018). Diagnosis and treatment of ADHD in children vs adults: What nurses should know. Archives of Psychiatric Nursing, 1-6. https://doi.org/10.1016/j.apnu.2018.06.013

National Institute of Mental Health [NIH] (2017). Attention-deficit hyperactivity disorder (ADHD). https://www.nimh.nih.gov/health/statistics/attention-deficit-hyperactivity-disorder-adhd.shtml

Psychology Today (2020a). ADHD psychiatrists in Cypress, TX. https://www.psychologytoday.com/us/psychiatrists/adhd/tx/cypress

Psychology Today (2020b). ADHD therapists in Cypress, TX. https://www.psychologytoday.com/us/therapists/adhd/tx/cypress  

Sadock, B.J., Sadock, V.A., & Ruiz, P. (2015). Synopsis of psychiatry: Behavioral sciences/ clinical psychiatry, 11th ed. Wolters Kluwer.

Truglio-Londrigan, M., & Lewenson, S.B. (2016). Assessment: Using the public health nursing assessment tool. Nurse Key – Fastest Nurse Insight Engine. https://nursekey.com/assessment-using-the-public-health-nursing-assessment-tool/

Washington State Nurses Association (2011). Public health and public health nursing. http://www.quadcouncilphn.org/wp-content/uploads/2016/03/2011_WSNA-Public-Health-and-PHN.pdf . Attention-Deficit Hyperactivity Disorder (ADHD) Essay.

ADHD in adults

Problem: 6.2 million adults in USA have ADHD but approximately 75% are undiagnosed.  Data does not exist to specify local rates of ADHD in adults in Cypress, TX.

Background: undiagnosed and untreated ADHD is associated with increased risk of poor school performance, job performance, relationship problems, & increased risk for motor vehicle accidents, specifically collisions.

Data collection:  standardized validated diagnostic screening forms Adult ADHD Self-Report Scale Symptom Checklist (ASRS) will be administered to a convenience sample of persons 18 y/o or older in the town of Cypress, TX.

Diagnosis:  screening results will be tabulated and compared against national statistics

Implementation: persons screening positive on ASRS will be referred to psychiatry clinic in the community for further evaluation to determine if diagnosis of ADHD is present.  Group education classes will be conducted and all persons screening positive will be offered this education class.

Evaluation:  Data collected, including number of persons screening positive for ADHD with ASRS, and number of persons receiving diagnosis of ADHD will be compared against national statistics to identify if local rates are greater than, equal to, or less than national statistics.  Data can be further broken down and analyzed to evaluate trends based on individual demographics.

Project on Undiagnosed adult with ADHD.

1.Look for data in Cypress Texas. U. S.A.

2.Add Advanced Public Health Nursing assessment, implementation of prevention programs in term of intervention for adult with ADHA.

3.Add Advanced Public Health Nursing scope of standard of practice on mental health in adult.  Attention-Deficit Hyperactivity Disorder (ADHD) Essay.