PROFORMA FOR REGESTRATION OF SUBJECT FOR DISSERTATION
S DILEEP G
I YEAR M. Sc NURSING
PSYCHIATRIC NURSING
YEAR 2010 -2011
IKON NURSING COLLEGE, BIDADI
BANGALORE - MYSORE ROAD
RAMANAGARA TALUKA
BANGALORE – 562109
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1 / NAME OF THE CANDIDATE AND ADDRESS / S DILEEP GI YEAR M. Sc NURSING
IKON COLLEGE OF NURSING
NO.32. BEEMANHALLI
BIDADI – 562109
BANGALORE-MYSORE ROAD
RAMANAGARA TALUKA
2 / NAME OF THE INSTITUTION / Ikon Nursing College,
Bangalore
3 / COURSE OF THE STUDY AND SUBJECT /
M. Sc Nursing
Psychiatric Nursing
4 / DATE OF ADMISSION / 30/07/20115 / TITLE OF THE TOPIC / A Study To Assess The Effectiveness Of A Self Instructional Module On Knowledge Regarding Identifying Attention Deficit Hyperactivity Disorder Among Parents Of Primary School Children At Selected Rural Community Area, Bangalore
6. BRIEF RESUME OF THE INTENDED WORK
6.1 INTRODUCTION
Children are the greatest gift of god to humanity. In India children from nearly 40% of the total population .The promotion healthy child development hasbecome a major focus of world attention over the last 3-4 decades.1
The frequency of ADHD in children, in various epidemiological studies, range from 2% to 10% and higher. The consensus, among experts in the field, places the incidence at 3% to 5%. The substantial variance, in findings, is related to several methodological differences, involving diagnostic procedures, age of informants, and differential inclusion of all sub types. There is a significance predominance of ADHD in boys. The ratio is found to be higher in clinic populations with the range of 2:1 to 10:1.2
Attention deficit hyperactivity disorder(ADHD) is a symptom of complex characterized by poor ability to attend a task, motor attractively and impulsivity. The essential features of ADHD is a persistent of inattention and hyperactivity that is more frequent and sever than is typically observed in child at a comparable development.3
TheADHD is also known as hyperkinetic disorder. It is a persistent pattern of inattention and hyperactivity more frequent and sever than typical of children at a similar level of development. The syndrome was first described by Heir rich Hoff. The causes of ADHD are divided into genetic factors, Biochemical theory, Pre, peri and postnatal factors, Environmental influences, psychosocial factors.4
Children with attention deficit often have been noted by their parents and teachers as destructive, misbehaved and dullard.This often leads to the resentment of the child by the parent. In addition, parents often feel disgusted to manage such a child. The very thought of inattentiveness among the children creates a distance among their normal counterparts from their home environment.Often they get blamed for no reason. The neurobiological problem resulting in attention deficit disorder in the child is still unexplored. The problems faced by these children are difficult, but not insurmountable. In order to achieve his or her full potential he / she should receive help, guidance and understanding from parents, guidance counselor and public education system.
ADHD is a disorder characterized by developmentally inappropriate and impairing in attention, hyperactivity and impulsivity. These core features give rise to deficits in social skills, academic performance, and following instructions. It is a chronic condition that persists for many throughout childhood, adolescence and into adulthood. About a third of children are described by their parents as overactive, and 5-20% of school children are so described by teacher. These reports encompass behavior varying from normal high sprits to a severe and persistent disorder. This over activity often varies in different situations. Hyperkinetic disorders are more sever forms of over activity, associated with marked inattention, hence the widely used term Attention deficit hyperactivity disorder (ADHD).5
On a research was conducted by EPHPP for reviews of effective community-based interventions to minimize the negative outcomes of children and youth with Fetal Alcohol Spectrum Disorder (FASD). That search revealed that most papers focused on screening and identification of infants and children with FASD. The papers related to interventions were of poor methodological rigour and most had very small sample sizes. A decision was made to undertake a review of reviews of community-based interventions for children with ADHD, a condition that is often co-morbid in Aboriginal children who have a diagnosis of FASD.6
About a third of children are described by their parents as overactive, and 5-20% of school children are so described by teacher. These reports encompass behavior varying from normal high sprits to a severe and persistent disorder. This over activity often varies in different situations. Hyperkinetic disorders are more sever forms of overactivity, associated with marked inattention, hence the widely used term Attention deficit hyperactivity disorder (ADHD).
6.2 NEED FOR THE STUDY
The National Collaborating Centre for Aboriginal Health (NCCAH) contracted with the Effective Public Health Practice Project (EPHPP) to conduct a review of reviews of community-based interventions to reduce the symptoms/negative outcomes of Attention Deficit Hyperactivity Disorder (ADHD) among children and adolescents. This work came about as a result of an earlier literature search conducted by EPHPP for reviews of effective community-based interventions to minimize the negative outcomes of children and youth with Fetal Alcohol Spectrum Disorder (FASD). That search revealed that most papers focused on screening and identification of infants and children with FASD. The papers related to interventions were of poor methodological rigour and most had very small sample sizes.8
Adults with ADHD are at increased risk for lost years of education, low occupational status, poor social relationships and drug abuse problems, as well as conflicts with the law. Medication, stimulants and non-stimulants are often the first line of intervention. Medication is effective only for about 70% of those diagnosed with ADH.9
A new model was invented on self regulation which has come to inform research on ADHD.This model has refocused research from an information processing paradigm to aframework that consider lack of behavioral inhibition is viewed as comprising two related processes: 1) The capacity to delay or inhibit responses for which immediate gratification is available and 2) The protection of this delayed response from collateral interference. Theoretical model places the capacity for behavioral inhibition at a central point in relation to four other executive functions, which depend on behavioral inhibition for their own effective execution. These are workingmemory; self-regulation of affect, motivation.10
An experiment study was conducted on Assessment of parents' preferences for the treatment of school-age children with ADHD. The treatment include parents' preferences, since parents' acceptance and support are crucial for ensuring treatment adherence and, as a consequence, good clinical outcomes. Discrete choice experiments are an important technique for identification and assessment of preferences for different treatment characteristics. Here qualitative and quantitative methods were used to ascertain the attributes that might influence a parent's choices for the optimal management of their child with ADHD. Attitudes were measured and analyzed using a classic rating scale (5-point Likert format) on behalf of their school-age children (6-14 years, 87% male). The study provides a valuable insight into parents' preferences regarding treatment for their child with ADHD.11
Epidemiological studies were conducted onprevalence of ADHD. The variation is due to a number of factors including the characteristics of the sample population (e.g. community, school, clinic, age, and gender), methods of diagnosis (e.g. parent versus teacher as informants, check-lists versus interviews), and the rigor with which the diagnostic criteria are applied. Recent work based on DSM IV criteria indicates a prevalence of 7.8% for ADHD in American school age children. The American National Institute of Mental Health estimates that between 3-5% of American preschool and school-aged children have ADHD. These investigators recommended that mutli-component community based interventions be developed and empirically tested. 12
A study was conducted on ADHD is a co-morbid condition in up to 85% of children with FASD. Others have also identified the potential connection between ADHD and FASD. This review of reviews was undertaken in order to gather the relevant principles and community-based strategies of programs developed for children and youth with ADHD and their families in the hopes that these strategies could be adapted and effectively used by children diagnosed with FASD.“Prevalent and represents a serious health threat in many Aboriginal communities” 13
A study was conducted on Parents of children with Attention Deficit/ Hyperactivity Disorder (ADHD) play an essential role in chronic care as they offer critical information to providers that drive appropriate education and disease management. We propose the development and evaluation of an electronic data entry tool that enables parents to communicate data essential to treatment of their children, regardless of their own literacy skills. The research plan addresses questions central to patient-centered information management: 1) how should a computer-based, personally controlled health record (PCHR) look and function to effectively gather data directly from patients, and, 2) how does health literacy influence parents' report of data on ADHD and the process-level events that result from parent-provider communication? The following specific aims organize the Formative research methods during PCHR development will use one on one cognitive interview, focus groups, and structured usability testing. The formal evaluation will study a diverse cohort of parents in a randomized trial of data entry (paper versus PCHR) for ADHD-specific information.14
Primary care records for children of this cohort will be analyzed for the prior 12 month period. Both a retrospective examination of documented ADHD processes of care and a prospective evaluation of the utility of data from the PCHR will occur. Literacy level is a primary variable of interest throughout the evaluation. This work addresses two health information technology goals of the Department of Health and Human Services: connectivity that provides clinicians with up-to-date patient data and the promotion of patient involvement in care. Findings will provide a usable and useful technology product that overcomes literacy related barriers and thereby improves care for the most common pediatric mental health disorder.15
Attention Deficit Hyperactivity Disorder (ADHD) is the most commonly diagnosed behavioral disorders during childhood. ADHD includes a heterogeneous array of symptoms which overlaps markedly with oppositional defiant disorder, conduct disorder, affective disorders such as depression, anxiety, learning disabilities, and communication disorders. The most common age for diagnosis is between the ages of 7 and 9, although symptoms may be apparent before the age of 3 however, many individuals are not diagnosed until a later age due to the prominent expression of ADHD symptoms in the school setting. ADHD is characterized by a persistent pattern of behavioral symptoms of inattention, hyperactivity, and impulsivity. Children showing behaviors that are characteristics of ADHD have been found to be highly “at-risk” for maladaptive educational and social outcomes.16
6.3 STATEMENT OF THE PROBLEM
A study to assess the effectiveness of a self instructional module on knowledge regarding identifying attention deficit hyperactivity disorder among parents of primary school children at selected rural community , Bangalore.
6.4 OBJECTIVES
- To assess the pre existing levelof knowledgeon attention deficit hyperactivitydisorder amongparents in experimental group and control group.
- To assess the level of knowledge of parents in experimental group and control group in identifying attention deficit hyperactivity disorder after administering self instructional module.
- To compare the level of knowledge of parents between experimental group and control group in identifying attention deficit hyperactivity disorder.
- To associate the pre test knowledge on identifying attention deficit hyperactivity disorders with the selected demographic variables in experimental group and control group.
6.5 OPERATIONAL DEFINITIONS
Effectiveness:
It refers to the extent to which the planed teaching programme has achieved the desired effect, determined by the gain in knowledge scores in the post test as measured by the structured knowledge questionnaire.
Self instructional module:
It refers to a selfinstructional unit that includes one or more learning objectives, appropriate learning materials and methods, and associated criterion-reference measures, regarding Attention deficit hyperactivity disorder.
Knowledge:
It refers to the level of understanding score of the parents are able to obtain in response to the questions relating to attention deficit hyperactivity disorder.
Attention deficit hyperactivity disorder:
It is a persistent pattern often fails to give close attention to the activities and often talks excessively with each behavior occurring infrequently alone and symptoms starting before seven years of age.
Parent:
It refers to either Mother or father, one who budgets, gives birth to, or nurtures and raises a child.
6.6 ASSUMPTIONS OF THE STUDY
It is assumed that:
- The parents of primary school children may have inadequate knowledge regarding attention deficit hyperactivity disorder
- The self instructional module may enhance the knowledge of the parents regarding attention deficit hyperactivity disorder
6.7 HYPOTHESES
H1:There will be significant difference between pre test and post test scores on attention deficit hyperactivity disorder among parents of control group and experimental group.
H2:There will be an increase in the post test knowledge scores after administration of the self instructional module.
H3:There will be a significant association of the post test knowledge on attention deficit hyperactivity disorder among parents with their demographic variables in control group and experimental group.
6.8 REVIEW OF LITERATURE
A literature review is a body of text that aims to review the critical points of current knowledge on a particular topic. It is also a critical analysis of a segment of a published body of knowledge through summary, classification, and comparison of prior research studies, reviews of literature, and theoretical articles.
A study was conducted on Parents were part of the treatment, but children and parents did not have to be seen conjointly. Treatment had to be clearly defined. Children had to be screened for ADHD using established clinical measures Mean sample size- 91; median sample size-67 Modality: Academic performance, self control, family functioning, internalizing problems, externalizing problems, social competence, child ADHD symptoms Academic problems were strongly affected by parent-involved treatment (ES-8.20); parent involved treatment had a low to moderate effect on other outcome measures: child self-control (ES-1.67); family function (ES-.67); internalizing problems (ES-.63); externalizing problems (ES-36); ADHD symptoms (ES-.40); social competence (ES-.07)Included studies were restricted to cognitive behavior theoretical orientation Findings tend to be based on a small number of studies Small number of studies means generalizability of conclusions should be viewed with caution17
A study was conducted in the community on 17 parent groups using videotaped vignettesin interactive Community-Based Interventional programme for Children and Adolescents with ADHD and their Families. Certain parents appear to have a non-optimal response to these programs. These include those with low socio-economic status, marital discord, parental psychopathology and inappropriate expectations. Among adolescents, several school-based interventions appear promising but have not been validated. These include behavior modification and note-taking training. The study made it evident to observe, that majority of the parent groups had no, ideology pertaining to ADHD.18
A randomized study was conducted in Madurai, India, that combined behavioral parent training with treatment for children and sought to generalize the effects of treatment on the home and school environments Total N= 322. Definition of ‘child’ or ‘adolescent’ left up to investigator to accommodate cultural differences. Treatment lasted 14 months. The incidences or severity of symptoms of inattention, impulsivity, and hyperactivity one study indicated that here was no difference detected between the efficacy of behavioral family therapy and treatment as usual in the community19
A prospectivepopulation-based study on problem behavior had to be relevant to school settings Study designs were between-group design, with-in group design or a single-subject design N=637 (ranging from 1-62 participants per study)Most participants were diagnosed with ADHD, HKD or ADD with no co morbidities All participants were in the public school system Length of interventions not described Follow-up ranged from 1 to 12 weeks, Cognitive-behavioral interventions focusing on the development of self-control skills and problem solving strategies Academic interventions focusing on the manipulation of antecedent conditions The results of the meta analysis indicate that school-based interventions for children lead to significant behavioral effects – effect sizes were moderate to high (i.e. 0.5 or higher) as ES ranged from non-significant to large, depending on analysis ES for behavior were 1.5 to 2 times greater than ES for academic performance.20
A longitudinal study evaluated non pharmacological interventions and combined interventions RCTs Treatment administered for 12 weeks or more N=623 Child therapy of various types (3) cognitive-behavioral therapy(2)combined psychosocial treatments (1) parent training (1)EEG biofeedback (1).The study resulted in minimum improvement in attention and no improvement in behavior or academic performance Biofeedback was superior to no treatment and CBT was superior to supportive therapy Combined therapy was superior to behavior therapy on oppositional or aggressive symptoms, teacher-related social skills, and parent-child relationships .21
A study was conducted to assess the individual psychological therapy with the child using cognitive or cognitive-behavioral therapy, some parent training in application of CBT principles as home as well as in behavior management, provision of a teacher-training component in some cases. These packages were not applied uniformly across the studies analyzed N-71Some co-morbid conditions allowed in inclusion criteria Interventions included: Contingency management, cognitive-behavioral therapy, individual psychotherapy, parent training and education, parent or family counseling or therapy, social skills training, EEG biofeedback or relaxation techniques,behaviors , not academic performance, cognitive function, neurological/physiological measures Psychological or behavioral therapies used alone appeared not to be efficacious in ADHD Results were hampered by the lack of data in primary studies included in the review Results came from a small number of studies with small sample sizes.22