ABSTRACTAttention deficit and attention deficit hyperactivity disorders (ADD/ADHD) are common aliments among children and adolescents. Untreated ADD/ADHD can have negative short- and long-term consequences. Effective management of ADD/ADHD can alternatively result in improved short-term success and positive long-term patient outcomes socially, emotionally, and academically. Treatment with medications, therapy-such as cognitive behavior therapy (CBT), other non-pharmacologic methods such as diet or exercise, or a combination of methods can result in enhanced treatment success.

PICO QUESTIONIn patients under 18-years-old with ADD or ADHD, how does treatment with medication compared to treatment with medication and nonpharmacologic inventions affect symptom control within a 6 months time period?

LITERATURE REVIEWADD/ADHD affects as much as 7% of the global population (1). As medical knowledge and understanding of ADD/ADHD expand, treatment options also increase. It is the responsibility of the family nurse practitioner (FNP) to be aware of what is existing and what is beneficial for ADD/ADHD treatment. • First line therapy for ADD/ADHD is typically

medication intervention. Researchers report that 70-80% of children and adolescents treated with medication for their ADD/ADHD symptoms showed an improvement in their symptom control (2).

• CBT may also provide benefit for individuals with ADD/ADHD. CBT can help improve the individual’s problem solving ability, reduce procrastination, and decrease distracting thoughts (3).

• Eating a well balanced diet, getting at least 30 minutes of exercise per day, and sleeping 8-9 hours per night can also help improve ADD/ADHD symptoms.

IDENTIFYING EFFECTIVE TREATMENT STRATEGIES FOR ATTENTION DEFICIT DISORDERS AMONG

CHILDREN AND ADOLESCENTSDixi Haramoto, BSN, RN, MSN-FNP Student

Implementation Plan• When children or adolescents present to

the clinic with concerns about ADD/ADHD behaviors, they will be screened utilizing the Vanderbilt assessment tool. If a diagnosis of ADD/ ADHD is confirmed, an initial treatment of medication or CBT will be prescribed.

• A follow-up appointment will be conducted at 4-6 weeks following the initiation of treatment.

• If symptoms remain uncontrolled, additional therapies will be considered.

• After one-year, research notes and data from patients’ charts will be reviewed to identify correlations with treatment method and symptom reduction. Vanderbilt scores and clinic notes will be studied and clinical findings will be submitted for publication.

How success will be measured• Project effectiveness can be determined

by the use of the Vanderbilt follow-up assessment scores. If providers use Vanderbilt assessments at the 4-6 week follow-up appointments, decreasing scores will indicate improvements in patient symptom management and treatment.

• Improving ADD/ADHD symptoms in children and adolescents is the goal of ADD/ADHD treatment. Thus, patient report of improved symptoms will be the ultimate guide as measured through Vanderbilt tools.

THEORETICAL FRAMEWORKPender’s health promotion model (HPM) shows that experiences of the individual, perceptions of benefits or barriers of performing an action, and expectations of behavioral outcomes guide one’s actions (6). This can be useful to understand as clinicians provide recommendations for treatment of ADD/ADHD. Any real or perceived barriers, expected outcomes, or previous claimed experiences with treatment methods may hinder a patient’s willingness to try a specific therapy or may contribute to an unrealistic or false understanding of the disease itself and expected treatment outcomes. Our goal with ADD/ADHD treatment is not necessarily an absence of disease but rather a positive state of well-being.

CONCLUSIONSCurrent first-line treatment recommendation for ADD/ADHD is medication therapy. Typically, patients will have a decrease in their symptoms with the use of a medication, but often symptoms persist and require additional therapies. CBT has been shown to be an effective method of symptom control. It can be used independently or in conjunction with medication for the treatment of ADD/ADHD. Many individuals treated with CBT alone also continue to have symptoms; however, when medication and CBT are used together, they provide the greatest symptom control for adolescents and children with ADD/ADHD.

REFERENCES1. Tosto, M. G., Momi, S. K., Asherson, P., & Malki, K. (2015). A systematic review of attention

deficit hyperactivity disorder (ADHD) and mathematical ability: Current findings and future implications. BMC Medicine, 13, 204.

2. Rosch, K. S., Fosco, W. D., Pelham, W. J., Waxmonsky, J. G., Bubnik, M. G., & Hawk, L. J. (2016). Reinforcement and stimulant medication ameliorate deficient response inhibition in children with attention-deficit/hyperactivity disorder. Journal of Abnormal Child Psychology, 44(2), 309-321. doi:10.1007/s10802-015-0031-x

3. Group CBT helps teens with persistent symptoms despite medication. (2015). Brown University Child & Adolescent Psychopharmacology Update, 17(6), 1-7. doi:10.1002/cpu.20231

4. Catalá-López, F., Hutton, B., Núñez-Beltrán, A., Page, M. J., Ridao, M., Macías Saint-Gerons, D., & ... Moher, D. (2017). The pharmacological and non-pharmacological treatment of attention deficit hyperactivity disorder in children and adolescents: A systematic review with network meta-analyses of randomized trials. PLOS ONE, 12(7), 1-31. doi:10.1371/journal.pone.0180355

5. Pelham, W. E., Fabiano, G. A., Waxmonsky, J. G., Greiner, A. R., Gnagy, E. M., Coxe, S., & ... Murphy, S. A. (2016). Treatment sequencing for childhood ADHD: A multiple-randomization study of adaptive medication and behavioral interventions. Journal of Clinical Child & Adolescent Psychology, 45(4), 396-415. doi:10.1080/15374416.2015.1105138

6. McEwen, M., & Wills, E.M. (2014). Theoretical basis for nursing (4th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

7. Burden, A. (2019). Photo: Silhouette of child sitting behind tree during sunset. Retrieved from https://unsplash.com/search/photos/school

8. Psyc3330 (2015). Symptoms of ADHD described by the literature. Wikimedia commons. Retrieved from ttps://commons.wikimedia.org/wiki/File:Proposed_Symptoms_of_ADHD.PNG

PROJECT METHODOLOGY

ADD/ADHD are some of the most commonly diagnosed disorders in children and adolescents (4). As such, it is imperative that FNPs are familiar with and comfortable in assessing, diagnosing, and treating these conditions. According to current research, there is not one treatment method that works best for all patients. The understanding is that treatment must be individualized, and often a combination of therapies work greatest to alleviate symptoms (5). Stimulant and non-stimulant medication, CBT, lifestyle modifications, or a combination of therapies can lead to greatest treatment success. Frequent follow-up should also be encouraged until ADD/ADHD symptoms are well managed. Knowledge of which treatment methods, or combination of methods, provide the greatest symptom reduction is the goal of this project.

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