Introduction
Attention deficit hyperactivity disorder is a neurodevelopmental disorder that affects an individual’s ability to pay attention due to being hyperactive. The condition affects 3-5% of young people and at least 5-7% of children worldwide (CDC, 2022). ADHD affects people’s learning, social relationships, and behaviors.
Gavin, a nine-year-old child, shows symptoms of ADHD that affect his ability to concentrate in class and at home, and to associate with people effectively. A mental health nurse could help Gavin by working with him, his parents, and the teacher for adequate recovery. This paper discusses various methods of treatment that are recommended for Gavin. It seeks to answer the question: “How can a community mental health nurse work with Gavin and his parents towards Gavin’s recovery?” The treatments, CHIME, behavioral therapy, and medication, will be designed according to his age. Therefore, the mental health nurse can work with Gavin, his parents, and the school teacher by implementing CHIME, medication, and behavioral therapy treatment.
Recovery-Oriented Methods of Treating ADHD
Treatment of ADHD is done considering a child’s or an adult’s age. The American Academy of Paediatrics (AAP) recommends parent training in behavioral management as the first line of intervention for children below six years (CDC, 2022). For children over six years old, the association recommends combining medication and behavioral therapy treatments alongside parent training in behavior management for children until they are 12 (CDC, 2022). Behavioral classroom intervention should be added for teachers’ support when children learn in schools (CDC, 2022).
The CHIME (Connectedness, Hope and Optimism, Identity, Meaning in Life, and Empowerment) framework could also be incorporated into Gavin’s line of treatment. Gavin qualifies for CHIME, medication, and behavioral therapy as recovery-oriented methods. Therefore, how can the nurse deliver these forms of treatment?
CHIME Model
CHIME is a personal recovery framework for people with mental illnesses. The model provides the mental health nurse with the patient’s recovery perspective through the five factors: connectedness, hope and optimism, identity, meaning, and empowerment. For Gavin, recovery means understanding one’s abilities and disabilities, gaining and retaining hope, autonomy, engagement in active life, a positive sense of self, social identity, and meaning and purpose (Carson & Hurst, 2021).
According to Carson and Hurst (2021), mental health nurses are best suited to help clients with each of the five factors. The nurse could foster hope and optimism through empowerment and encouragement. Connectedness, identity, and meaning come from the family and the people Gavin interacts with. Gavin could derive a sense of identity by doing what he likes with the nurse’s help.
Medication
A mental health nurse can deliver the intervention by diagnosing and administering the proper medication to Gavin. The study by Hallahan and Morris (2022b) shows that medication can help children manage their daily symptoms of ADHD and thus function effectively. The Food and Drug Administration (FDA) has approved several medications classified as stimulants and non-stimulants (CDC, 2022).
Stimulants such as amphetamine, methamphetamine, and methylphenidate are the most well-known and widely used to manage ADHD (Hallahan & Morris, 2022b). According to the CDC (2022), 70-80% of children show fewer symptoms of ADHD when taking fast-acting medications. In 2013, the FDA approved non-stimulant medications for the condition, including Strattera, Kapvay, and Intuniv (CDC, 2022). Although non-stimulants do not act as quickly as stimulants, their effect can last up to 24 hours, thus making them effective as well.
AAP warns that medications affect children differently and may show varied side effects. Some of the medications’ most common side effects are sleep problems and decreased appetite (CDC, 2022). While one child may respond well to a drug, another responds negatively.
Therefore, AAP recommends that healthcare providers try different doses and medications. The mental health nurse must observe and adjust Gavin’s medication dosage to find the right balance between side effects and benefits (CDC, 2022). Furthermore, the parents should work closely with the healthcare provider to find the best medication for the child.
Behavioral Therapy for Gavin
The most timely intervention for Gavin is training parents in behavioral management. However, the nurse could also consider other forms of behavior management techniques. For example, they could recommend or deliver Cognitive Behavioural Therapy (CBT). According to Cork/Kerry Child and Adolescent Mental Health Service (CAMHS), there is little evidence that CBT helps manage ADHD (Hallahan & Morris, 2022a).
CBT is helpful for people who, even after receiving medications, still show significant symptoms of ADHD, including loss of self-control, impaired listening and expressing skills, and poor social skills (Hallahan Morris, 2022a). CBT is a talking technique that involves conversations about one’s behavior and what can be done to alter it positively. Although not very effective, this therapy could help Gavin by recommending what he can do to behave better.
Before the nurse can start the behavioral therapy, it is essential to note Gavin’s positive traits, which could be used as behavior encouragement. Hallahan and Morris (2022b) state that children with ADHD could have positive traits such as being enthusiastic and friendly, having a great sense of humor and fun, having a high level of creativity, especially in the arts, and having the ability to think outside the box (Hallahan & Morris, 2022b). The mental health nurse treating Gavin should recognize traits that make him stand out. The nurse must encourage Gavin to take more positive actions to overcome the negative ones (Hallahan & Morris, 2022b). The mental health nurse should educate Gavin’s parents on the significance of receiving parent training in behavioral management.
Parent Training in Behavioural Management
In addition to working with Gavin and the nurse in CBT, the parents should be taught how to manage the child’s behavior. The concerned nurse should, therefore, train both of Gavin’s parents on ways to control his behaviors. The following are things the parents need to know and do to help the child recover.
The parents should create a routine with the same schedule for essential activities such as bed and wake-up time (CDC, 2022). They should manage distractions by turning off the TV and creating a positive atmosphere when Gavin does homework. Most children with ADHD learn well while moving and listening to music (CDC, 2022). Gavin should be encouraged to put his toys, school bags, and clothes in the same place daily.
Additional tips for parents whose children have ADHD include limiting the children’s choices, being clear and specific, and disciplining effectively. The parents should limit Gavin’s choices to prevent him from feeling overwhelmed (CDC, 2022). Limiting choices could mean offering the double child types of toys, games, or clothes to choose from instead of multiple choices.
Sometimes, giving children with ADHD bulk information or unclear instructions could distract their attention (CDC, 2022). Gavin’s parents could solve such a problem by being specific about what is expected of them and constantly reminding them of what is expected of them. When Gavin does not listen, do what is expected, or gets in trouble, the parents should discipline him (CDC, 2022). Effective discipline requires parents to avoid spanking, yelling, or scolding, instead using time-outs and removing privileges.
Adapting a positive lifestyle could also decrease Gavin’s ADHD symptoms. The parents should adopt a healthy lifestyle, including nutritious food, increased physical exercise, and sufficient sleep (CDC, 2022). Consumption of nutritious food helps balance the emotions of children with ADHD. Doing lots of physical exercises could help reduce Gavin’s movements because his hyper energy is lost in exercise. Finally, adequate sleep helps individuals manage their anxiety levels and thus control their emotions.
Another way Gavin’s parents could help manage his behavior is by praising and rewarding positive habits. According to the CDC (2022), parents could set goals and list their child’s positive behaviors. Gavin’s parents should tell him when he does right by praising or rewarding him. Furthermore, the parents must set realistic goals and recognize a child’s small steps toward positive behavior. Since Gavin’s symptoms include problematic behavior in school, the mental health nurse should also recommend school support in behavioral management.
Classroom Behaviour Management Techniques
The mental health nurse could also educate Gavin’s teacher about classroom behavioral management techniques to help Gavin and children who might need related help. Incorporating the teacher in Gavin’s behavioral management process would help in reducing symptoms of ADHD in class, thus being more focused. Classroom education requires teachers to know and do the following things. The teacher could put Gavin in a classroom position free of distraction, especially away from the windows and doors (Hallahan & Morris, 2022c). The aim is to put the student nearest the teacher to prompt, correct, and support him in tasks.
Putting him close to the teacher is also helpful in monitoring his behaviors (Hallahan & Morris, 2022c). The teacher should also place Gavin near a well-motivated and positively behaved student for better influence. The teacher should remember to redirect Gavin’s attention whenever he starts wandering in class (Hallahan & Morris, 2022c). They could redirect by asking questions like, “Where are you at with your task?” The teacher should also find opportunities to provide feedback for positive performance.
Another helpful technique is breaking longer assignments into smaller tasks to allow Gavin to manage chunks of work. According to Hallahan and Morris (2022c), children with ADHD may lack the ability to concentrate for a long time and thus may not finish longer assignments. Breaking down the assignments also helps the child find the least boring and monotonous tasks.
Conclusion
The mental health nurse could work with the boy, his parents, and educators to use CHIME, medication, and behavioral management in a recovery-oriented manner. The CHME framework informs the nurse on the right path toward helping Gavin recover. Stimulants and non-stimulants are recommended forms of immediate intervention for Gavin. CBT and educating parents about behavioral management tools could help reduce the child’s problematic habits. Effective treatment of Gavin’s ADHD would require a combination of the model, medication, and behavior management for quicker recovery.
Reference List
Carson, J., & Hurst, R. (2021). Mental health nursing and recovery: the C-CHIME model. British Journal of Mental Health Nursing, 10(2), pp. 1-3. Web.
Centre for Disease Control and Prevention (2022) Treatment of ADHD. Web.
Hallahan, K. and Morris, L. (2022a) ‘Attention deficit hyperactivity disorder: information for adolescents’, Cork/Kerry Child and Adolescent Mental Health Service, pp. 1–26.
Hallahan, K. and Morris, L. (2022b) ‘Attention deficit hyperactivity disorder: information for children’, Cork/Kerry Child and Adolescent Mental Health Service, pp. 1–14.
Hallahan, K. and Morris, L. (2022c) ‘Attention deficit hyperactivity disorder: information for teachers’, Cork/Kerry Child and Adolescent Mental Health Service, pp. 1–30.