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ADHD Nursing team

Kate Nicholls - ADHD Nurse Specialist (working days Monday-Thursday)

Donna Milner - ADHD Nurse Specialist (working days Tuesday-Friday)

Emma Caswell - ADHD secretary - emma.caswell@jpaget.nhs.uk or 01493 452673

We are a team specialising in working with children and young people from 6 to18 years of age with a formal diagnosis of ADHD, and supporting them with their ADHD medication needs.

Within the team we have two specialist nurses who are non-medical prescribers. Emma Caswell is the team’s secretary.

Our service at the James Paget University Hospital is to monitor and manage ADHD medication regimes for children and young people with a formal diagnosis of ADHD. We work collaboratively with other professionals to ensure children and young people’s needs are met.

 

What is ADHD

ADHD stands for Attention Deficit Hyperactivity Disorder

ADHD is a neurodevelopmental disorder that causes difficulties in at least two settings, home life, education or work.

Symptoms of ADHD in children and young people - https://www.nhs.uk/conditions/attention-deficit-hyperactivity-disorder-adhd/symptoms/

The symptoms of ADHD in children and teenagers are well defined, and they're usually noticeable before the age of six.

They occur in more than one situation, such as at home and at school.

Children may have symptoms of both inattentiveness and hyperactivity and impulsiveness, or they may have symptoms of just one of these types of behaviour.

 

Inattentiveness, Hyperactivity and Impulsiveness

    • having a short attention span and being easily distracted
    • making careless mistakes – for example, in schoolwork
    • appearing forgetful or losing things
    • being unable to stick to tasks that are tedious or time-consuming
    • appearing to be unable to listen to or carry out instructions
    • constantly changing activity or task
    • having difficulty organising tasks
    • being unable to sit still, especially in calm or quiet surroundings
    • constantly fidgeting
    • being unable to concentrate on tasks
    • excessive physical movement
    • excessive talking
    • being unable to wait their turn
    • acting without thinking
    • interrupting conversations
    • little or no sense of danger

    These symptoms can cause significant problems in a child's life, such as underachievement at school, poor social interaction with other children and adults, and problems with discipline.

  • Although not always the case, some children may also have signs of other problems or conditions alongside ADHD, such as:

    • Anxiety disorder – which causes your child to worry and be nervous much of the time; it may also cause physical symptoms, such as a rapid heartbeat, sweating and dizziness
    • Oppositional defiant disorder (ODD) – this is defined by negative and disruptive behaviour, particularly towards authority figures, such as parents and teachers
    • Conduct disorder – this often involves a tendency towards highly antisocial behaviour, such as stealing, fighting, vandalism and harming people or animals
    • Depression
    • Sleep problems – finding it difficult to get to sleep at night, and having irregular sleeping patterns
    • Autistic spectrum disorder (ASD) – this affects social interaction, communication, interests and behaviour
    • Dyspraxia – a condition that affects physical co-ordination
    • Epilepsy – a condition that affects the brain and causes repeated fits or seizures
    • Tourette's syndrome – a condition of the nervous system, characterised by a combination of involuntary noises and movements (tics)
    • Learning difficulties – such as dyslexia

Based on the types of symptoms, three kinds (presentations) of ADHD can occur:

  • Combined Presentation: if enough symptoms of both criteria inattention and hyperactivity-impulsivity were present for the past 6 months
  • Predominantly Inattentive Presentation: if enough symptoms of inattention, but not hyperactivity-impulsivity, were present for the past six months
  • Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-impulsivity, but not inattention, were present for the past six months.

Because symptoms can change over time, the presentation may change over time as well.

https://www.cdc.gov/ncbddd/adhd/diagnosis.html

 

Medication review

A photograph of a health professional measuring the height of a little girl, who stands next to a wall while a measuring device is brought down to the top of her head A little girl stands on flat weighing scales and she is looking down at what the scales read.  A photograph of a woman having her blood pressure taken. She has the cuff around her arm.

During the appointment we will routinely monitor blood pressure, height and weight. We will also ask the child/ young person how they are managing life at home and school.

Medication reviews generally occur every six months unless there is a clinical reason to be seen earlier. Between these times Emma Caswell (ADHD team secretary) can be contacted (details above) for medication queries.

As we are not an emergency service, it may take the team a few days to call back for urgent matters. Parents/ guardians may be asked to gather some evidence from school to help the nurses understand the child/ young person’s difficulties further.

 

NICE guidance on diagnosis and treatment of ADHD; https://www.nice.org.uk/guidance/ng87