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2 Peds ADHD
| Question | Answer |
|---|---|
| ADHAD DSM IV 5 Criteria: 1) significant and age-appropriate s of inattention and/or hyperactivity/impulsivity. 2) Have onset prior to age 7. 3)Cause some impairment in two or more settings. AND | 4)Cause significant impairment in social, academic, or occupational functioning. 5)Are not better accounted for by another mental disorder |
| ADHD Clinical presentation in Preschool (Age 3-5) | motor resltessness, insatiable curiosity, vigorous and often destructive play, demanding, argumentative, excessive temper tantrums, low levels of compliance |
| ADHD Clinical presentation in School Age (Ages 6-12) Third grade is the most common age of referral (kids are usually beginning to go to multiple classes). Missing social cues | easily distracted, hw poorly organized and contains careless errors or incomplete, blurts out answers before q's completed, often disruptive in class, interrupts of intrudes on others and displays aggression. Perception of "immaturity" |
| ADHD Clinical Presentation in Adolescents (ages 13-18): sense of inner restlessness, school work disorganized and shows poor follow-through; fails to work independently. | Engaging in "risky" behaviors (speeding and driving mishaps), poor self-esteem, poor peer relationships, difficulty with authority figures |
| ADHD Clinical Presentation in Adulthood: disorganized, fails to plan ahead. Forgetful, loses things. Difficulty in initiating and finishing projects or tasks | Misjudges available time. Inattention/concentration problems. May have job instability and marital difficulties. Hyperactivity sx decrease with age |
| ADHD Myths | "fad" diagnosis, increasing in prevalence, overdiagnosed, overmedicating kids , kids grow out of it, can diagnose with a brain scan, tx with ritalin leads to drug addiction |
| What percent of kids with ADHD are being treated? | about 50% of kids are being treated who have been diagnosed. Only 10% of adults are being treated |
| Risk of 1st MVA in ADHD kids and non ADHD kids | equal for 1st MVA. But ADHD have more recurrent and more severe |
| ADHD genetic basis | one of the most heritable of all psychiatric disorders (more than depression, psychiatric). .7-.8 heritability (similar to height and IQ) |
| The primary NT that the drugs for ADHD target | dopamine |
| Gene by environment interactions | Several recent studies have found that interactions among genes, environmental variables, and ADHD outcomes |
| Basal ganglia in ADHD pts | particularly the caudate (which is at the anterior of the basal ganglia) appears to be smaller in ADHD pts compared to non-ADHD pts. Cortical thinning also noted. |
| ADHD in children as they progress to adolescents | 30-80% will exhibit sx into adolescents. up to 65% of adolescents will exhibit sx into adulthood |
| Diagnostic Assessment of ADHD | PE, Observation, Standard Assessment Measures, Interview and History (most critical) |
| ADHD Tx interventions without conclusive evidence of efficacy | congnitive therapy, individual psychotherapy, biofeedback, vitamin/mineral tx, chiropractice tx, food allergy treatments |
| Evidenced Based treatments for ADHD | Medication, Psychosocial/Behavioral Interventions (parent training, classroom interventions, summer treatment programs) |
| Only non-stimulant approved for ADHD | Strattera/atomoxetine - SNRI |
| Net effect of stimulant medications | to increase dopaminergic transmission |
| Triad of sx associated with ADHD | Impulsivity, Inattention, and hyperactivity. |
| 3 ADHD subtypes | hyperactive impulsive, inattentive, and combined |
| Progression of ADHD into adulthood | hyperactivity declines more quickly, and impulsivity and inattentiveness often persist into adolescence and adulthood. |
| Behavior Modification techniques may include | structure with consistency in daily routine, positive reinforcement whenever possible, and time out for negative behaviors. |
| Epidemiology of ADHD | 2-10% of school aged children, Worldwide Prevalence: 5.29%, Boys:Girls is 2:1, |
| Inattentive Presentations: failure to giev close attention to detail, difficulty sustaining intention in task, failure to listen when spoken to directly, failure to follow instructions, difficulty organizing tasks and activities, and | reluctance to engage in tasks, losing utensils necessary for tasks or activities, easy distractibility, forgetfulness in daily activities |
| Hyperactive-Impulsive Presentations: Fidgetiness, difficulty remaining seated in class, excessive running or climbing, difficulty engaging in quiet activities, and | excessive talking and blurting out answers before questions have been completed, difficulty awaiting turns, interrupting and intruding on others |
| Number of symptoms that child must have to be considered ADHD | 6 of the list |
| AEs of Methylphenidate and Dextroamphetamine (atomoxetine has a similar AE profile) | appetite suppression and sleep disturbances. Stimulants may exacerbate psychotic sx and motor tics. HA, Stomachache, irritability, dysphoria, behavioral rebound |
| Buproprion | an antidepressant medication that can also be effective for tx of ADHD sx; CI in pts with hx of seizures b/c it will lower seizure threshold. More commonly used in older than younger. |
| Alpha2 adrenergic presynaptic agonists | clonidine and guanfacine: decrease norephinephrine levels. Particularly helpful in pts who are hyperreactive to stimuli and may decrease motor tics |
| # of non-responders to pharmacological treatment | 5-25% |
| Best Tx for ADHD | Combine Pharmacologic Tx wtih psychosocial tx. |
| Educational Interventions | preferential seating in the classroom, a system of consistent positive behavior reinforcement, consistent structure, repition of info when needed, use of auditory and visual teaching modalities. |
| Psychosocial Tx | Social skills training, individual counseling is beneficial in alleviating poor self-esteem, oppositional behavior, and conduct problems. |
| Methylphenidate | Ritalin |
Created by:
ltm12