Children with ADHD in a rural community
Miller, Debra Joan
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Children with ADHD experience a myriad of chronic behavioral and academic difficulties. If attributes among rural children are similar to those described by studies conducted on the urban population, educators and health care professionals may have grossly underestimated the public health impact of ADHD Research does not provide adequate descriptive data of children with ADHD in rural communities and until more is known about actual attributes of these children, there will continue to be disparities in identification, access to treatment, and reports of the manifestations of ADHD and its co-existing conditions. Levine's Conservation Model- Nursing Process in the Community provides the theoretical framework for the study. A Descriptive Correlational study is conducted to gain information on the demographic attributes; to identify the distribution of ADHD subtypes; and to explore the comorbidity associated with ADHD in rural children. The sample consists of 88 children seen at a pediatric outreach clinic located in a rural community in southern Wyoming. Secondary data analysis makes the study exempt from IRB review. Descriptive statistics are used to organize and analyze the data. Because of the small sample size, results may only indicate potential trends. Findings may not be statistically significant but clinically they assisted the community in proposing systems for establishing family-centered, community-based care. The gender ratio is similar to those of larger studies with more boys than girls diagnosed. This raises the continued concern that ADHD may be under-diagnosed in girls in rural communities. Caucasians are diagnosed more frequently, raising the concern that minorities are under-diagnosed or underrepresented in research. Findings on the distribution of subtypes is somewhat ambiguous when compared to other studies. Most of the children were diagnosed during school transition times (1st and 3rd grades). Psychological comorbidities were diagnosed in 27.3% and 55.7% were identified with learning disabilities. Sleep disturbances were frequently associated with the diagnosis of ADHD and depression was found to contribute substantially to sleep disturbances. ADHD can be characterized by heterogeneity and ambiguity, and confounded by comorbidity. Nurse Practitioner strategies should include: collaborative assessment; case planning; advocacy; management; and building systems to provide a multimodal approach to interventions.