Running head: ATTENTION DEFICIT HYPERACTIVITY DISORDER

A School-Age Child with Attention Deficit Hyperactivity Disorder

Leah Aragon and Tuyet Nguyen
California State University, Stanislaus

ATTENTION DEFICIT HYPERACTIVITY DISORDER

A School-Age Child with Attention Deficit Hyperactivity Disorder

The quality of the functional relationship between the child and family members, peers,
society, mass media, and culture are major factors affecting the emotional and physical health of
the child. A family nursing assessment shows the strengths and weaknesses of the family, thus
effective nursing interventions can be identified and implemented based on the assessment
(Hockenberry & Wilson, 2009). Adam Hernandez, an 8-year-old boy, will be assessed,
observed, evaluated, and compared in terms of his physical, cognitive, social, psychological, and
moral development to the normal development of the typical 8-year-old-boy. Based on the
findings, health promotion and anticipatory guidance will be identified and offered to the
Hernandez family and Adam.
The Hernandez family is a traditional nuclear Mexican-American family, including a
married couple and two biological children (Hockenberry & Wilson, 2009). John Hernandez is
45-years-old and is married to Ramona Hernandez who is 40-years-old (Ramona Hernandez,
personal communication, September 4, 2013). John was born in the United States and has a
mechanical college degree. He lost his job as a security system technician two years ago due to a
back injury and is currently working as a mechanical technician in San Jose. Ramona Hernandez
was born in Mexico and has a high school diploma. She enjoys being a stay-at-home mom,
keeping the house organized, and taking care of her family. Kevin Hernandez is their 20-yearold son who has a high school diploma. He moved out earlier this year and is currently looking
for a job. Adam Hernandez, an 8-year-old third grader, was diagnosed with Attention Deficit
Hyperactivity Disorder (ADHD) when he was 4-years-old. ADHD is a condition which shows a
persistent pattern of inattention and hyperactivity-impulsivity that interferes with functioning or
development (Center for Disease Control and Prevention [CDC], 2013).

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John plays the traditional male role of breadwinner and is usually gone from 6am until
7pm every weekday. Ramonas role is to cook, clean up the house, and take care of Adam. John
admits that he has an impatient personality when dealing with Adam. At home, Ramona is the
main socializing agent as she primarily interacts with him during play time, while doing
homework, and even sleeping at night. During the interview, Adam ran around, climbed up on
the kitchen countertop, and jumped down. He constantly interrupted his mother as she answered
the interview questions and screamed when she ignored him. Meanwhile, John just shook his
head.
The age difference between Adam and Kevin is 12 years. According to Ramona, Kevin
feels annoyed when Adam wants to play with him. While Ramona is busy cooking or cleaning,
Adam usually plays video games or watches television without a time limit. Thus, mass media
also plays an important socializing agent to Adam. Since Adams parents seem to have limited
control over him, the parenting style is laissez-faire (Hockenberry & Wilson, 2009).
The Hernandez familys religion is Catholic. They strongly believe in God and go to
church every Sunday. They value their health and promptly seek medical help when it is needed.
The family currently has private health insurance. Since Adam was diagnosed with ADHD four
years ago, they have been seeking treatments, including medications, medical advices, and an
herbal remedy called Focus Formula. So far, they have not had any negative experiences with
health care. However, they stopped giving Adam medications and the herbal remedy and are
trying to replace it with the natural treatment of calming with love and attention.
Ramona usually cooks traditional Mexican foods. She believes that eating fresh homemade foods is important to keep the whole family healthy. They only eat fast food every other
weekend. At home, the family neither sits at the dining table nor eats at the same time. Adam is

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allowed to eat snacks throughout the day and sometimes refuses to eat lunch or dinner. Ramona
usually takes Adam to the park nearby the house three times per week to allow him to be active.
He often gets hurt and refuses to wear a helmet when riding the bicycle. His parents usually
follow him to ensure his safety. John usually stays up late after getting home from work. Adam
watches television or plays games until 10pm after his mother helps him with homework. He is
often reluctant to go to bed and sleeps in the same bed as his mother on a regular basis. Except
John who drinks one to two beers per day, the rest deny drug and alcohol use.
Upon assessment, Adam is well groomed boy of normal weight with dark hair and tan
skin. His gait and posture are steady and smooth with no difficulty moving. His teeth appear
white with some cavities. There is no odor of breath or body noted. He is approximately 54 lbs.
and 50 inches tall. According to the CDC (2009), his weight belongs to 25th-50th percentile, and
his height belongs to 50th percentile. Overall, Adams growth development is normal compared
to a typical 8-year-old boy.
In addition to family and mass media, school also has an important influence on a schoolage child. Compared to the typical 8-year-old boy, Adam can read, write, understand the
concept of conversion, and classify objects. Adams temperament is identified as the difficult
child due to ADHD which causes his highly active, irritable, and irregular habit; therefore, Adam
requires a more structured environment (Hockenberry & Wilson, 2009).
Fine and gross motor development during the school years is marked by an increase of
coordination, balance, strength, and endurance (Hockenberry & Wilson, 2009). Compared to the
typical 8-year-old boy, Adams fine and gross skills meet the standard. His gross motor skills
are indicated by running around, climbing up, jumping down, and riding his bicycle. The ability
to draw toy cars, dress himself, and play video shows his fine motor skill and good coordination.

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During the school years, peers have a significant influence on childrens ability to gain
independence from parents and deal with dominance and hostility (Hockenberry & Wilson,
2009). Compared to the typical 8-year-old boy, Adam is having more difficulty getting along
with his friends because of his ADHD which leads to feelings of frustration and isolation.
According to Eriksons psychological development, a sense of industry versus inferiority
is very important at his age (Hockenberry & Wilson, 2009). Adams ADHD steers him toward
inferiority. Sitting still, paying attention, and following the class rules become real challenges
for Adam. For example, he always ran around, jumped, and interrupted the teacher with many
questions while everyone was sitting quietly on the floor during reading time. Even though he
never gets As in any subject because of his short span attention, his mother says that he is doing
above average. Since he often breaks the class rules, he comes home and complains with his
parents about being called a dump kid by his friends. Adams parents deal with this situation
by giving him love and attention.
Piagets period of concrete operation refers to the school-age period when children are
able to use thought processes to experience events and actions and understand the concept of
conversation and classification (Hockenberry & Wilson, 2009). Adam can do a simple math
conversation, see things from anothers point of view due to less prominent of egocentric view,
and loves to collect toy cars. These are considered normal compared for the cognitive
development of a typical 8-year-old boy (Hockenberry & Wilson, 2009).
Kohlberg moral development during the school years emphasizes the importance of
developing a conscience and ability to understand and adhere to rules and standards set by others
(Hockenberry & Wilson, 2009). Compared to a typical 8-year-old child who is considered a
good student when following the class rules, Adam does not meet the standard. One example

ATTENTION DEFICIT HYPERACTIVITY DISORDER

is being called a dump kid by Adams friends because he often breaks the class rules.
Health promotion is important in the care of this child and his family. First, nutritional
guidance is necessary due to his lack of routine healthy meals. During middle childhood, a taste
for a variety of food develops and likes and dislikes are established (Hockenberry & Wilson,
2009). Empty calorie snacks decrease Adams appetite for nutrient dense meals while
stimulating the hyperactivity of his ADHD. Instead of allowing Adam to choose when and what
he eats, Adams parents should establish family eating time where healthy meals are served.
Especially for a child with ADHD, consistency is important. Meals should be eaten at the family
dinner table around the same time every day without distractions and should last at least 20
minutes. This also allows time for the family to develop socially and creates a positive social
attitude about food. Creating boundaries for nutrition allow Adam to reach nutritional goals
necessary for optimal growth while learning discipline and developing social skills (Hockenberry
& Wilson, 2009).
Another important health promotion topic concerning physical health for the school-age
child is dental health. Dental caries during school years are very important since permanent teeth
are growing. Adam and his parents were taught to limit sweet snacks and the correct ways to
brush and floss at least twice a day and after eating. They were encouraged to continue their
regular dentist visits as recommended. Positive reinforcement using rewards toward Adams
cooperative behavior can be used at this time (Hockenberry & Wilson, 2009).
The Hernandez familys laissez-faire parenting style requires developmental and social
health promotion nursing interventions. Upon assessment, Adams father admitted to avoiding
taking disciplinary action and Adams mother pleased him. Proper boundaries are especially
important yet difficult in a child with ADHD because of maladaptive behavior patterns and

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inattentiveness. Along with creating set meal times, homework and play times should be
organized and followed to allow consistency. Television and video games should be limited to
two hours per day. The parents also were taught that books are good for Adams growth and
development. Rewarding the desired behavior of obeying these rules and using consequences for
disobeying are beneficial for Adams age and disorder to teach him discipline. When
disciplining, it is important to be specific to the undesired action to promote proper behavior
while maintaining a positive self-esteem (Hockenberry & Wilson, 2009).
Injury prevention is an important teaching topic for the Hernandez family due to his
hyperactivity and their laissez-faire parenting style. His mother stated that he has been injured in
the past from his hyperactivity in activities. Children often lack the cognitive ability to predict
dangerous situations and have a higher risk for injury (Hockenberry & Wilson, 2009). Adam
stated understanding of the importance of wearing a helmet when driving his bicycle and his
parents agreed that it should be enforced.
The Hernandez family has both internal and external resources. Their main internal
resource is a traditional nuclear family with a stable marriage. External influences include
Adams school, mass media, and the Catholic Church they attend weekly. Local ADHD support
groups were suggested to benefit Adam and the Hernandez family.
The Hernandez family, with a hardworking father, a stay-at-home mother, an older son,
and 3rd grader Adam, are dealing with Adams ADHD to the best of their ability with the
knowledge they have. It is the nurses role to provide teaching in order for Adam to grow and
develop as a healthy child despite his disorder. Health promotion in nutrition, dental health,
setting boundaries, and preventing injury were especially emphasized in this case. With more
information, Adam and his family are more likely to have a better quality of live with ADHD.

ATTENTION DEFICIT HYPERACTIVITY DISORDER

References
Center for Disease Control and Prevention. (2013). Attention-Deficit Hyperactivity Disorder
(ADHD). Retrieved from http://www.cdc.gov/ncbddd/adhd/diagnosis.html
Center for Disease Control and Prevention. (2009). CDC growth charts: United States
Retrieved from http://www.cdc.gov/growthcharts/data/set1/chart03.pdf
Hockenberry, M. J., & Wilson, D. (2009). Wongs essentials of pediatric nursing. (9th ed.). St.
Louis, MO: Mosby/Elsevier.