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![ADHD FUN FACTS & STATS
• Attentional problems are actually a result of not being
able to regulate attention, not just being unable to pay
attention. Over-focusing can be a major problem as
well.
• Using medication for ADHD does not lead to future drug
abuse and may decrease the chance that adolescents
with ADHD self medicate…[with illicit substances]
(CADDAC, 2015)](https://image.slidesharecdn.com/94455801-bcc6-4194-87fa-ba79b8102ec1-160319184956/75/GMAC-Disruptive-Behaviour-Disorders-16-2048.jpg)
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GMAC Disruptive Behaviour Disorders
- 1. J E FF R E Y C H E N G R N B S C N C A S A 1 D E C 2 0 1 5 ADHD, ODD, CD WITHIN CHILD & ADOLESCENT POPULATION
- 2. OUTLINE • ADHD definition,presentation types, and stats • Overview of ADHD Stimulant and Non Stimulant Medication • Definition, risk factors of Oppositional Defiant Disorder (ODD) • Medications for ODD • Definition, risk factors of Conduct Disorder (CD) • Medications for CD • Nursing Approaches
- 3. ATTENTION DEFICIT HYPERACTIVITY DISORDER(ADHD) • a recognized medical neurodevelopmental disorder affecting both children and adults • Surrounded by misunderstanding and stigma • Some see it as behavior as opposed to a medical condition or mental health problem • The most commonly diagnosed disorder of childhood/adolescence (CASA Core Content, 2012)
- 4. ATTENTION DEFICIT HYPERACTIVITY DISORDER(ADHD) • Displays symptoms that fall within three core features of ADHD in a persistent or ongoing pattern: Hyperactivity Inattention Impulsivity • Must be present in more than one setting • Ex. Symptoms persist at home and at school • Must cause functional impairment that gets in the way of daily life or typical development. (CASA Core Content, 2012)
- 6. ADHD INATTENTIVE PRESENTATION •Fails to give close attention to details or makes careless mistakes. • Has difficulty sustaining attention. • Does not appear to listen. • Struggles to follow through on instructions. • Has difficulty with organization. • Avoids or dislikes tasks requiring a lot of thinking. Loses things. • Is easily distracted. • Is forgetful in daily activities. (DSM V, 2014)
- 7. ADHD HYPERACTIVE-IMPULSIVE PRESENTATION • Fidgetswith hands or feet or squirms in chair. • Has difficulty remaining seated. • Runs about or climbs excessively in children; extreme restlessness in adults. • Difficulty engaging in activities quietly. Acts as if driven by a motor • Talks excessively. • Blurts out answers before questions have been completed. • Difficulty waiting or taking turns. • Interrupts or intrudes upon others. (DSM V, 2014)
- 8. ADHD COMBINED INATTENTIVE& HYPERACTIVE-IMPULSIVE PRESENTATION • Has symptoms from both of the prior presentations. • Most common presentation (CADDAC) 50-75% 20-30% < 15% Combined Type Predominantly Hyperactive- impulsive Predominantly Inattentive
- 9. ADHD & SCHOOLKIDS • Easily distracted • Homework poorly organized, careless errors, often incomplete or lost • Low academic scores • Frequent trips to the principal’s office • Blurts out answers before question completed (often disruptive in class) • Often interrupts and intrudes on others
- 10. ADHD & SCHOOLKIDS • Low self-esteem • Displays aggression • Difficult peer relationships • Does not wait turns in games • Often out seat • Perception of “immaturity” • Unwilling or unable to do chores at home • Accident prone
- 11. ADHD & ADOLESCENTS •May have sense of inner restlessness rather than hyperactivity • Procrastinates and displays disorganized school work with poor follow-through • Fails to work independently • Poor self-esteem • Poor peer relationships
- 12. ADHD & ADOLESCENTS •Inability to delay gratification • Specific learning disabilities • Behavior not usually modified by reward or punishment • Engages in “risky” behavior (speeding, unprotected sex, substance abuse) • Difficulties or clashes with authority • Disregard for own safety (injuries or accidents)
- 13. ADHD FUN FACTS& STATS • ADHD occurs in 5 to 12% of school age children world wide. • ADHD is the most common mental health disorder in children. • 80% maintain the diagnosis into adolescence. • 60% are still affected by core symptoms in adulthood. (CADDAC, 2015)
- 14. ADHD FUN FACTS& STATS • ADHD is under-diagnosed and under-treated. • Research shows that ADHD is most likely inherited • Predominately Inattentive ADHD (ADD) often goes undiagnosed until later in life. • Parenting styles do not cause ADHD. • Diets and limiting food additives and sugar will not cure ADHD. (CADDAC, 2015)
- 15. ADHD FUN FACTS& STATS • New research shows that problems with executive functioning greatly affect those with ADHD. (CADDAC, 2015) • As per Understood.org, ADHD can impact executive functioning as follows: • External Issues • Being disorganized • Losing things all the time • Poor time management • Inability to complete a task • Inability to make a plan (and follow it) • Internal Issues • Difficulty deciding what’s important/unimportant when reading or listening • Problems absorbing/retaining what is taught in school • Problems understanding and following verbal directions • Problems organizing thoughts • Problems with clear, organized writing
- 16. ADHD FUN FACTS& STATS • Attentional problems are actually a result of not being able to regulate attention, not just being unable to pay attention. Over-focusing can be a major problem as well. • Using medication for ADHD does not lead to future drug abuse and may decrease the chance that adolescents with ADHD self medicate…[with illicit substances] (CADDAC, 2015)
- 17. ADHD FUN FACTS& STATS • ADHD is expressed differently between genders • Socialization of females • Comorbid depression higher in females • Girls are underdiagnosed • Hyperactivity is usually absent in girls • Diagnostic criteria geared more towards males (CASA Core Content, 2012)
- 18. ADHD FUN FACTS& STATS Children and adolescents with untreated ADHD are at a greater risk for: -problems with learning, resulting in less academic success -dropping out of high school -poor self esteem -substance abuse -increased parent-child conflict and stress -sustaining injuries and having accidents -more mental health issues as they grow up -problems with social skills and peer relationships -increased number of driving accidents and severity -becoming a juvenile offender (CADDAC, 2015)
- 19. ADHD TREATMENT =MULTI MODAL APPROACH • …a combination of psychotherapeutic, psychoeducational, and psychopharmacological interventions • ADHD is presented as a chronic condition that must be managed through life • Capacity building within child and influential adults is key • Unified consistent approach across all environments
- 20. ADHD TREATMENT =MULTI MODAL APPROACH • Medications • Behavioral intervention strategies • Target one or a select few behaviors at a time with a care plan that is communicated to the team and across environments • Building capacity within the child/youth: • Organizational skills • Self regulation to soothe and cope with everyday stressors • Social skills training in areas such as leadership, teamwork, boundaries • Anger management • Mindfulness for self awareness • Elements of CBT to help sensitize interconnectedness of thoughts, feelings, and actions (CDC, 2015)
- 21. ADHD TREATMENT =MULTI MODAL APPROACH • Parent training to build capacity • School accommodations and interventions • Coding from public schools for individualized programming or behavioural classes • Preschool-aged children (4–5 years of age) with ADHD, behavior therapy is recommended as the first line of treatment (CDC, 2015)
- 22. TYPES OF ADHDMEDICATIONS Psychostimulants concerta ritalin dexedrineVyvanse adderall Non Stimulants intuniv XR stratteraclonidine
- 23. SELECTION OF ADHDMEDICATIONS Stimulant? Non stimulant? comorbid psychiatric / medical disorder Adapted from CADDRA guidelines
- 24. COMORBIDITIES • ADHD comorbiditiesare common and can complicate treatment Tic ADHD ODD/CD Depression/anxiety disorders BPD Learning disorders Trauma Adapted from DSM V
- 25. 1ST LINE TREATMENT •Long Acting Stimulants • Can be a cognitive enhancer • Influences activity of the central and peripheral nervous systems. • Improves alertness, awareness, wakefulness, endurance, productivity, motivation, attentiveness • Taken once a day • Trial for monotherapy first then followed by adjunctive therapy with second line meds if desired clinical response is not achieved (CADDRA)
- 26. 1ST LINE: BIPHENTIN Longacting methylphenidate-based stimulant • Duration: approx 10 to 12 hours • Granules be sprinkled into yogurt, apple sauce for consumption • Narc count required by two nurses • Recently moved off triplicate which enhances accessibility
- 27. 1ST LINE: CONCERTA Longeracting methylphenidate-based stimulant • Duration: approx 10 to 12 hours • Commonly prescribed for adolescent population • Narc count required by two nurses
- 28. 1ST LINE: ADDERALLXR • Long acting amphetamine mixed salts capsules • Duration approx 12 hours • Granules have abuse potential to be crushed and snorted for enhancing studying or recreational use • Narc count required by two nurses
- 29. 1ST LINE: VYVANSE Longacting lisdexamfetamine-based stimulant • Duration approx 13 hours • Narc count required by two nurses • Abuse potential lower due to dexamphetamine remaining inactive medications until specific enzyme in red blood cells metabolize into an active form within the body
- 30. SECOND LINE/ADJUNCTIVE AGENTS •Short Acting to intermediate acting stimulant preparations • Dexedrine, Ritalin • Can be prescribed as PRNs • Long acting Alpha2-Adrenergic Agonist Antihypertensive Intuniv XR as adjunctive or monotherapy in select cases • Strattera/Atomoxetine for monotherapy or adjunct • To augment long-acting formulations early or late in the day, or early in the evening • Used when long acting agents are too expensive or not covered by insurance • Medical contraindications to stimulants • (positive cardiac history, hallucinations)
- 31. 2ND LINE: INTUNIVXR / GUAFACINE • Alpha2-Adrenergic Agonist Antihypertensive • Duration: up to 24 hour • Affects receptors in parts of brain that lead to strengthening working memory, reducing distraction, and improving attention and impulse control. • Lessens ADHD sx: disruptive, inattentive, hyperactive, impulsive, irritability • Considered safe for children aged 6-12 with sub-optimal response to psychostimulants either as an adjunctive therapy to psychostimulants or as a monotherapy (Health Canada) • First line choice as long acting agent if long acting psychostimulants not a good fit for patient
- 32. 2ND LINE: STRATTERA/ ATOMOXETINE • Norepinephrine reuptake inhibitor • Duration: up to 24 hrs • Can be used as monotherapy (CADDRA) • Off label use as adjunctive to first line pyschostimulant (CADDRA) • Ex. Concerta and Strattera
- 33. 2ND LINE: RITALIN Shortacting methylphenidate-based stimulant • Can augment Biphentin® or Concerta® (CADDRA) • Duration: 3 to 4 hours • Most popular out of ADHD medications for abuse potential recreationally crushed and snorted • Can be used actively or PRN basis • Narc count by two nurses
- 34. 2ND LINE: DEXEDRINE Short& intermediate acting dextroamphetamine- based stimulant • Can augment Adderall XR® or Vyvanse® (CADDRA) • Duration • Pill: approx 4 hours • Spansule: approx 6 to 8 hours • Pill form has abuse potential to be crushed and snorted • Narc count by two nurses
- 35. NURSING CONSIDERATIONS FOR STIMULANTS •Stimulants • Increased risk of suicidal thoughts and behaviors in some people; benefits still outweigh risks (Health Canada) • Ensure safety planning in collaboration with in patient team and patient • In community, case conference with school, mental health, social work, caregivers, youth workers to safety plan.
- 36. NURSING CONSIDERATIONS FOR STIMULANTS •Can suppress appetite • Ensure adequate dietary intake • Breakfast time is essential to load up for the day • Meds may be given with or before breakfast • Ensure healthy snacks are available throughout the day • Collaborate with school board to ensure that snacks are available to child when they get hungry • Tweak snack times at home as well • Can cause rapid heartbeats • Ensure vitals are being done including height and weight on a routine basis to monitor Only at the discretion of the prescribing doctor, ha! Ideally, ECG done to assess for cardiac defects or arrhythmias prior to commencement of any ADHD medications
- 37. 3RD LINE • Offlabel use of medications for ADHD • Considered if 1st and 2nd line medications are not working or deemed inappropriate due to medical reasons, comorbidities, mental health • Treatment by these medications should be initiated by specialists only or in consultation with a specialist in ADHD.
- 38. 3RD LINE: WELLBUTRIN/BUPROPRION • Norepinephrine reuptake inhibitor antidepressant • Used with ADHD and comorbid depression • Monitor for increased suicidality and self harm actions • Safety plan with child and team
- 39. 3RD LINE: CLONIDINE/DIXARIT •Alpha2-Adrenergic Agonist Antihypertensive • Duration: 3 to 6 hours • Often starts with HS dose of 0.025 to 0.05 mg and titrates to QID depending on severity of behaviors, night awakenings, clinical response
- 40. 3RD LINE: CLONIDINE/DIXARIT •modulates noradrenergic tone in the prefrontal cortical (PFC) influencing aspects of behavior, cognition, and impulsivity (Medscape) • directly promotes functional connectivity of PFC networks and resulting in enhanced regulation of attention and behavior (Medscape) • Commonly used in Edmonton with foster child population three to twelve years when managing disruptive behaviors
- 41. NURSING CONSIDERATIONS FOR ALPHA2-ADRENERGICAGONIST ANTIHYPERTENSIVES • Ex. Intuniv XR, Clonidine • ADHD drugs may increase risk of suicidal thoughts and behaviors in some people; benefits still outweigh risks (Health Canada) • Ensure safety planning in collaboration with team and patient • Ensure vitals are being done on a routine basis and monitor for hypotension at commencement of medication • Abrupt cessation can cause rebound hypertension, gradual titration is good practice • Potential falls risk due to dizziness from hypertensive medication
- 42. CADDRA GUIDELINES FOR PHARMACOLOGICALTREATMENT OF ADHD 1st line 2nd line 3rd line "Off label" if 1st & 2nd line drugs don’t work Wellbutrin Clonidine Short / Intermediate Acting Intuniv XR Strattera Dexedrine Ritalin Long Acting Vyvanse Adderall XR Biphentin Concerta Adapted from CADDRA
- 43. OPPOSITIONAL DEFIANT DISORDER (ODD) •Characterized by a pattern of negativistic, defiant, disobedient and hostile behaviors, at least 6 month duration and 4 out of 8 of the following: • often loses temper • often argues with adults • often actively defies rules or refuses to comply • often deliberately annoys other people • often blames others for mistakes • often touchy or easily annoyed by others • often angry and resentful • often spiteful and vindictive Adapted from DSM V
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- 45. ODD • Causes clinicallysignificant impairment in social, academic or occupational functioning • Doesn’t occur exclusively during psychotic or mood disorder • Doesn’t meet criteria for conduct disorder
- 46. ODD RISK FACTORS •Temperament prone towards reactivity • Disrupted attachment to primary caregiver • Neglect • Lack of supervision • Physical or sexual abuse • Frequent changes in caregivers • Early institutionalization in group homes • Association with delinquent peer groups • Parents or caregivers with conduct disorder, ETOH abuse, mental illness • Adapted from DSM V
- 47. ODD MEDICATIONS • Clonidinevery commonly used with children under twelve for explosive disruptive behaviors • Psychostimulants and antipsychotics may be used together if ADHD comorbid • Atypical antipsychotics for explosive anger • Risperdal and Quetiapine more common • Olanzapine at times
- 48. ODD INTERVENTIONS • Parenttraining in behaviour management • Building capacity within the child/youth: • Self regulation to soothe and cope with everyday stressors • Social skills training in areas such as leadership, teamwork, boundaries, conflict management • Anger management • Mindfulness for self awareness • Elements of CBT to help sensitize interconnectedness of thoughts, feelings, and actions • Problem solving skills
- 49. CONDUCT DISORDER A patternof violating the rights of others and/or major social norms, in the past twelve months, in at least 3 of the following: • Aggression to people and animals • Destruction of property • Deceitfulness or theft • Serious violation of rules/law Adapted from DSM V
- 50. Bang, Bang! Pointing Loaded Gun AtPolice Resisting Arrest ? Homicide Evading Police Juvenile Detention Death Threats Reckless Driving Parole Violations Discharging Firearms despite Conditions Drug trafficking and manufacture
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- 53. ANTI-SOCIAL PERSONALITY DISORDER •A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by three (or more) of the following: • Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest. • Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure. • Impulsivity or failure to plan ahead. • Irritability and aggressiveness, as indicated by repeated physical fights or assaults. • Reckless disregard for safety of self or others. • Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations. • Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another. • The individual is at least age 18 years. • There is evidence of conduct disorder with onset before age 15 years. DSM V
- 54. CONDUCT DISORDER RISKFACTORS • Disrupted attachment to primary caregiver • Neglect • Lack of supervision • Exposure to antisocial acts of criminality, violence • Parental substance abuse • Physical or sexual abuse • Frequent changes in caregivers • Early institutionalization in group homes • Association and socialization with delinquent peer groups • Parents or caregivers with conduct disorder, ETOH abuse, mental illness Adapted from DSM V
- 55. CONDUCT DISORDER MEDICATIONS •Medications may reduce aggressive behavior and antisocial acts with co-morbid impulsivity • Long acting stimulant: Concerta • Very common with remanded youth • Atypical antipsychotics: • Risperdal, Quetiapine for highly aggressive youth • Abilify is well tested for adolescent population in managing aggressive behavior
- 56. CONDUCT DISORDER INTERVENTIONS •Parent and family intervention when possible • Family Therapy • Building capacity in parents/care givers for behavioral management • Praise • Giving commands • Limit setting • Consequencing • Planning a tangible reward system
- 57. CONDUCT DISORDER INTERVENTIONS •Multi-systemic therapy where available to build capacity within the youth: • Self regulation to soothe and cope with everyday stressors • Social skills training: leadership, teamwork, boundaries, conflict management • Anger management • Mindfulness to enhance self awareness and well being • Elements of CBT to help sensitize interconnectedness of thoughts, feelings, and actions • Problem solving skills • Communication skills • Addictions counselling (lifestyle, substances, process) • Solicitor General • Youth Criminal Justice Act • Intensive Rehabilitative Custodial Sentencing (IRCS)
- 58. NURSING CONSIDERATIONS ODD/CD MEDICATIONS •Atypical Antipsychotics • Ongoing monitoring for vitals, weight, BMI • Scheduled bloodwork for metabolic disturbances • CAMESA guidelines for antipsychotic monitoring • http://camesaguideline.org/information-for-doctors • Risperdal --- lactate monitoring • High levels can cause gynecomastia • Olanzapine --- metabolic disturbance risk highest of all • Clonidine • Monitor for hypotension at commencement • Safety precautions for falls risk • To emergency or contact doctor if child faints
- 59. TANGIBLE REWARD SYSTEMFOR DISRUPTIVE KIDS/YOUTH • Children and adolescents with Disruptive Behavior Disorders do not respond to natural (intrinsic) rewards as well as typical youth • Focus on rewarding positive behavior • Repeated consequencing of bad behavior can desensitize youth and lose its effect • The training of health care staff, parents and teachers in the use of tangible rewards within their environments is effective in increasing desired behaviors • Can use token systems, behavior charts, or immediate rewards • In-patient example: • Earning privileges to go off unit or buy canteen items
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- 61. CARE PLANS Consistency ofplan should be across all environments that a child participates within • Collaborative multi-disciplinary approach that may involve teachers, teaching aide, behavioral specialist, OT, mental health professionals, caregivers, youth workers, caseworker • Involve the child if possible. • A version of the care plan should be written for them in a way they can easily follow and understand.
- 62. CARE PLANS What canbe outlined in a care plan? • De-escalation tactics that have been historically successful • Taking child out of class for a walk if they begin to wind up • Sensory object to soothe or use when feeling frustrated or overwhelmed • Alternative step down activities in class if having a challenging day • Whether the child works better with males vs females • Strategies for disciplining and debriefing • Tangible Rewards
- 63. CARE PLANS • Theuse of a care plan can help the team and oncoming shifts stay consistent in managing a child across environments and interventions. • Can help reduce splitting and confusion that a child may otherwise experience and contribute to their frustration and acting out behaviors • The resulting display of disruptive behaviors may then be dealt with the prescribing of additional medication • or even worse…..ending up using chemical or physical restraints
- 64. SAFETY IS PRIORITY •Base all your clinical decisions around patient and staff safety • Assess the team members you have on shift for competency and cohesion when engaging in activities that require supervision and elements of risk • Airing court, escorts to and from programs • Plan shift accordingly with awareness of strengths and weaknesses of your team • Casual vs permanent staff • Male vs female • Individual staff member strengths and weakness • Plan who does the restraint, who retrieves strong sheets, who traffic controls the patients
- 65. MAINTAIN APPROPRIATE BOUNDARIES •Don’t be their friend or buddy • Don’t give them your cell phone to text their friends • Don’t show pictures of yourself in a bikini on your last Mexican vacation • Do not engage in conversation with innuendo • Do not put yourself in vulnerable positions for other staff to question your boundaries • Secretive prolonged conversations in obscure parts of unit • Spending time alone in a patient’s room • Do not engage in sexual relations with patients
- 66. DON’T WORK HIGH,DRUNK, OR HUNG OVER • Children and youth require a lot of attention • Being present and engaged can mean the difference between a safe shift and an incident • Not a good look on worksites where staff are dependent on each other for supervision and safety • Better judge the dynamics on the unit, between patients and staff
- 67. DO NOT SLEEPIN FRONT OF PATIENTS • Puts yourself at risk to be physically assaulted • Unprofessional • Puts staff and patients at risk if supervision is necessary component of the work place
- 68. ENSURE ROUNDS AREGETTING DONE • Follow unit protocol • One of the easiest practices to ensure safety on a unit but commonly dismissed • An accurate and up to date rounds board enhances safety and awareness that may be crucial during an unforeseen incident • Ie. evacuation due to fire, violent incident, lockdown
- 69. FIND YOUR VOICE •The voice you use when you “Talk that Talk” • A mixture of assertiveness, confidence, life experience, sincerity, empathy, and a dose of commandeering • Cue negative behaviors in a firm manner and give time for someone to respond / comply • Be sensitive to developmental levels, cognitive delays • Over-cuing in a chiding, hostile, aggressive manner does not build rapport or trust • Puts yourself and others at risk for violent situations • Tends to make youth ignore or dismiss you more
- 70. DO NOT ARGUEWITH EACH OTHER IN FRONT OF PATIENTS • If a call has already been made by a staff member, roll with it, if it doesn’t harm the youth in way of traumatizing the child or being overtly punitive • Use nursing station to debrief, work out conflicts, disagreements amonst staff • Don’t argue with another staff in front of the patient • Strive to move in unison and as a cohesive unit in front of the patients • Remember….eyes and ears are always watching, listening, and studying to look for weakness and loopholes
- 71. GET DOWN • Physicallyget down to a kid’s level to interact and build rapport • Meet the youth where they’re at • Take an interest in their interests • Don’t judge their interests • Be open and let them teach you • Find that “in” • Music is a great entry point
- 72. DISCIPLINING/CONSEQUENCING • Sanction proportionately,promptly, and specifically to a behavior or incident (American Academy of Pediatrics (AAP), 2014) • Be cool, calm, and consistent when disciplining (AAP, 2014) • Be aware of your paraverbals when providing discipline • Discipline is used to guide and teach instead of focusing on punishing (AAP, 2014)
- 73. DISCIPLINING/CONSEQUENCING • Discuss asa team and decide together the best course of action, document as such • When safe to do so, always consider debriefing about incident or behaviors that brought on discipline to offer feedback and teaching • Be sensitive to developmental level of the person, do not just go by age or blanket sanction • Weigh out cognitive functioning, IQ, and developmental delays • time orientation can be very different for lower functioning kids, shorter times is better • Seclusion room only for situations where child poses risk to himself and/or others
- 74. EMPHASIZE STRENGTHS Notice andpraise good behavior (AAP, 2014)
- 75. BE CONSISTENT • Maintaina structured, consistent environment (AAP, 2014) • Set and uphold clear and realistic expectations that are developmentally realistic (AAP, 2014) • Given the opportunistic nature of the youth, the deviation from structure/routine on your shift may severely impact the safety of staff incoming on the next shift
- 76. ROLE MODEL • Yourinteractions with the kids contribute to overall therapeutic milieu (AAP, 2014) • Act the way you want to see the kids behave (AAP, 2014) • Be aware of your paraverbal communication • Intonation, volume, body language speak volumes about you and can invite or repel therapeutic rapport
- 77. BE A LEADER •Doesn’t just start and end with the charge nurse • Take control of your own nursing game and develop a consistent brand amongst the team and patients • Remain professional and committed • Communicate intelligently • Watch what you say and how you act from day one • Build relationships with other health disciplines to network • Learn the hierarchy and system which you operate within to navigate • Leadership can mean being engaged and involved with • Case conferencing • Helping draft care plans for your patients to minimize staff splitting and enhancing consistency • Help facilitating prosocial activities for children and youth • Remaining consistent with unit structure and routine • Contribute your thoughts and voice to help decision making
- 78. REFERENCES • Canadian ADHDResource Alliance (CADDRA) http://www.caddra.ca/pdfs/caddraGuidelines2011Chapter07.pdf • CASA Children, Family and Adolescent Mental Health ADHD Core Content 2012 • Center for ADHD Awareness Canada (CADDAC) http://www.caddac.ca/cms/page.php?138 • Centers for Disease Control and Prevention (CDC) http://www.cdc.gov/ncbddd/adhd/treatment.html • Diagnostic and Statistical Manual of Mental Disorders FIFTH EDITION DSM-5® Edited by American Psychiatric Association, 2013. • Government of Canada: Healthy Canadians Portal http://healthycanadians.gc.ca/recall-alert-rappel- avis/hc-sc/2015/52759a-eng.php • Medscape Website, http://www.medscape.org/viewarticle/577743 • Understood, For Learning And Attention Issues Website, https://www.understood.org/en/learning- attention-issues/child-learning-disabilities/executive-functioning-issues/difference-between-executive- functioning-issues-and-adhd