Nursing Guide to ADHD: Nursing Diagnosis, Interventions, & Care Plans

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects both children and adults. It’s characterized by continual patterns of inattention, hyperactivity, and impulsivity that interfere with functioning or development. Symptoms typically occur before age 12 and can continue into adulthood, where they may present differently. Those with ADHD may struggle with focusing on tasks, following through on instructions, staying organized, or regulating their behavior. 

ADHD is classified into three main types: predominantly inattentive, predominantly hyperactive-impulsive, and combined presentation. Early identification and intervention can greatly improve outcomes for those with this condition by helping them manage symptoms and improve their quality of life. 

Etiology and epidemiology 

The exact cause of ADHD isn’t clear; however, it’s believed to be a result of a combination of genetic, environmental, and neurobiological factors. Research suggests that ADHD runs in families, indicating a genetic predisposition. Environmental risk factors, such as prenatal exposure to alcohol, tobacco, or other substances, premature birth, and low birth weight, may also contribute to the development of ADHD. 

ADHD affects approximately 5% to 7% of children and 2% to 5% of adults worldwide, with males more frequently diagnosed than females in childhood. However, ADHD may be underdiagnosed in females (both children and adults) due to differences in symptom presentation, such as less hyperactivity and more issues with attention and focus. 

Key risk factors: 

• Family history of ADHD
• Prenatal exposure to tobacco, alcohol, or other substances
• Premature birth or low birth weight
• Early exposure to environmental toxins (e.g., lead) 

ADHD ICD-10 code 

• ICD-10 code for ADHD: F90.9 (Attention-deficit hyperactivity disorder, unspecified type) 

ADHD diagnosis 

ADHD is diagnosed based on clinical criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Patients must exhibit symptoms for at least six months, and symptoms must cause significant impairment in two or more settings (e.g., home, school, or work). The diagnostic process often involves gathering information from parents, teachers, and caregivers, as well as completing rating scales or standardized behavior assessments. 

ADHD symptoms 

Inattention 

• Difficulty sustaining attention on tasks or activities
• Frequent careless mistakes in schoolwork or work tasks
• Difficulty organizing tasks or managing time
• Forgetfulness in daily activities (e.g., missing appointments)
• Avoiding tasks that require sustained mental effort 

Hyperactivity/impulsivity 

• Fidgeting or difficulty remaining seated
• Running or climbing in places where it’s inappropriate (in children)
• Talking excessively or interrupting others
• Difficulty waiting for one’s turn
• Impulsive decisions without considering the consequences 

Diagnostic tools 

• Clinical interview: A thorough interview with the patient, parents, or caregivers to assess symptoms and rule out other conditions.
• Behavioral rating scales: Standardized scales such as the Conners' Rating Scales or the Vanderbilt ADHD Diagnostic Rating Scale are often used to assess the severity and range of ADHD symptoms.
• Neuropsychological testing: This may be used to assess cognitive functions, attention, and executive functioning, especially in complex cases or when there are co-occurring disorders. 

Differential diagnoses include learning disabilities, anxiety, depression, and autism spectrum disorder (ASD), all of which can present with overlapping symptoms. 

Management 

ADHD management typically involves a combination of behavioral therapy, medications, and lifestyle modifications. The approach is tailored to the individual’s needs, age, and the severity of symptoms. In children, behavioral interventions often focus on improving school performance, social interactions, and managing disruptive behavior. 

ADHD treatment options: 

Medications 

Stimulants 

• Methylphenidate (e.g., Ritalin, Concerta) and amphetamine-based medications (e.g., Adderall, Vyvanse) are the most effective and commonly prescribed treatments for ADHD. These medications increase the levels of dopamine and norepinephrine in the brain, improving attention and impulse control. 

Non-stimulants 

• Atomoxetine (Strattera): A non-stimulant medication used when stimulants are not effective or contraindicated.
• Guanfacine and clonidine: Alpha-2 adrenergic agonists are used primarily in children to improve attention and reduce hyperactivity. 

Behavioral therapy 

• Cognitive behavioral therapy (CBT): CBT is especially helpful in older children and adults with ADHD to create coping strategies, enhance organizational skills, and control impulsivity.
• Parent training: For younger children, parent training programs can teach caregivers how to implement strategies to improve the child’s behavior and emotional regulation at home.
• Classroom interventions: For school-age children, individualized education programs (IEPs) and 504 plans can provide academic accommodations to support learning and reduce distractions. 

Lifestyle modifications 

• Routine and structure: Encourage patients to follow daily routines, use planners or digital reminders, and break tasks into smaller steps to enhance organization and time management.
• Exercise: Regular physical activity has been shown to improve attention and reduce hyperactivity.
• Diet and sleep: Promote a balanced diet and healthy sleep hygiene, as poor nutrition and sleep deprivation can worsen ADHD symptoms. 

ADHD nursing care plan 

Nursing considerations 

Nurses can help in managing ADHD by providing education, supporting medication adherence, and helping families implement behavioral strategies. Nurses can assist with monitoring medication effects, encouraging adherence to therapy, and offering resources to support academic or occupational success. 

Assessment 

• Psychosocial assessment: Evaluate the patient’s emotional well-being, relationships, and daily functioning, including school or work performance.
• Medication review: Assess the patient’s current medications, including any side effects or concerns related to stimulant or non-stimulant medications.
• Family/caregiver involvement: Explore the family dynamics, assess stressors, and provide education on how to support the patient at home. 

Nursing diagnosis/risk for 

• Impaired social interaction related to impulsivity or hyperactivity
• Deficient knowledge related to understanding ADHD and its management
• Risk for ineffective therapeutic regimen management related to difficulty with time management and attention 

Interventions 

• Give education on ADHD. Provide the patient and family with information on ADHD, including treatment options and behavioral interventions.
• Offer medication management. Educate the patient and family about prescribed medications, proper dosing schedules, and potential side effects. Monitor for changes in symptoms and any adverse effects.
• Support behavior strategies. Encourage the use of behavior modification strategies, including positive reinforcement, time management techniques, and the establishment of structured routines.
• Provide referrals to specialists. Coordinate with psychologists, psychiatrists, or occupational therapists when specialized interventions are needed. 

Expected outcomes 

• The patient will demonstrate improved focus and attention with appropriate medication or behavioral therapy.
• The patient will achieve improved academic or occupational performance through individualized support and strategies.
• The patient and family will verbalize their understanding of ADHD and its treatment options.
• The patient will report improved emotional regulation and decreased impulsivity. 

Individual/caregiver education 

Education can help patients and their caregivers understand ADHD and manage symptoms effectively. Consider the following with patient education: 

• Medication adherence: Stress the importance of taking medications as prescribed and monitoring for any side effects.
• Behavioral strategies: Teach caregivers or patients how to implement behavior management strategies, such as using checklists, schedules, and visual aids to stay organized.
• Involvement in care: Encourage families to stay involved in the patient’s care and work closely with teachers or employers to provide consistent support across settings.
• Lifestyle modifications: Promote healthy lifestyle habits, including regular exercise, adequate sleep, and balanced nutrition to support cognitive functioning. 

References 

1. Centers for Disease Control and Prevention. (2023). ADHD. Retrieved from https://www.cdc.gov/adhd/
2. ICD-10 Data. (2023). F90.9 - Attention-deficit hyperactivity disorder, unspecified type. Retrieved from https://www.icd10data.com/ICD10CM/Codes/F01-F99/F90-F98/F90-/F90.9