Attention Deficit Hyperactivity Disorder

Attention Deficit Hyperactivity Disorder-
Attention Deficit Hyperactivity Disorder (ADHD)-
-ADHD is characterized by inattention, impulsiveness, restlessness, executive dysfunction, and emotional dysregulation

-Symptoms of ADHD of hyperactivity or impulsivity are less recognizable in adults

-The pathogenesis of ADHD in adults is not known

-The two major scales for diagnosing ADHD are the Conners' Adult ADHD rating scale and Adult ADHD self report scale

-The DSM 5 criteria for diagnosis of ADHD are below:
A.  A persistent pattern of inattention and/or hyperactivity and impulsivity that interferes with functioning and development as characterized by (1) or (2)

1.  Inattention-Six or more of the following symptoms have persisted for at least six months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities

-Fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities
-Has difficulty sustaining attention in tasks or play activities
-Doses not seem to listen when spoken to directly
-Does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace
-Has difficulty organizing tasks and activities
-Avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort
-Loses things necessary for tasks or activities
-Is easily distracted by extraneous stimuli
-Is forgetful in daily activities

2.  Hyperactivity and Impulsivity-  Six or more more of the following symptoms have persisted for at least 6 months that is inconsistent with developmental level and negatively impacts directly on social and academic/occupational activities.

-Often fidgets with or taps hands or feet or squirms in seat
-Often leaves seat in situations when remaining seated is expected
-Often runs or climbed in situations where it is inappropriate
-Often unable to play or engage in leisure activities quietly
-If often "on the go" acting as if driven by a motor
-Often talks excessively
-Often blurts out an answer before a question has been completed
-Often has difficulty waiting turn
-Often interrupts or intrudes on others

B.  Several inattentive or hyperactive symptoms were present prior to age 12.

C.  Several inattentive or hyperactive symptoms are present in two or more settings

D.  There is clear evidence that the symptoms interfere with, or reduce the quality of social, academic, or occupational functioning

E.  These symptoms dod not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another psychiatric disorder

-Differential diagnosis includes:  depression, mania, anxiety disorders, and substance abuse disorders

-Up to one third of children with ADHD will have one or more coexisting condition (learning disabilities, oppositional defiant disorder, conduct disorder, anxiety disorder, mood disorders, tics, and sleep disorders)

-Children 4-18 can typically be managed by their primary care provider without a comorbid problem

-Specialities that have to sometimes be involved include:  developmental behavior pediatrician, child neurologist,  psychopharmacologist, child psychiatrist, and clinical child psychologist.

-Treatment modalities include:  behavior interventions, pharmacotherapy, combinations therapy, school based interventions, social skills training, and psychotherapy interventions

-Medications with or without behavior/psychologic interventions are first line therapy for school aged patients

-Trial of medications for school aged children or adolescent, a stimulant is considered first line.  Concerta is choice

-Straterra can be considered an alternative to stimulants

-Dosing for ADHD has 3 stages:  titrations, maintenance and termination

-Also need to look at does the child need it during summer or on weekends