ADHD Flashcards
ADHD
A neurodevelopmental disorder characterized by difficulties with attention, hyperactivity, and impulsivity.
Symptoms
Hyperactivity
Impulsivity
Inattention
What age to symptoms commonly present?
- 3-7 yrs
- May not be noticed until after 7yrs
Non-drug treatment
- Lifestyle - diet + exercise
- Parent training/ education programmes
- Environmental modifications
- CBT
When would you recommend drug treatment in children?
- ONLY for SCHOOL-children (5 years and above)
- They should have moderate-severe symptoms
- And had not responded sufficiently to non-drug treatment
What do you do if the child in under 5?
- If under 5 years old then
ONLY under the advice of a specialist
Which drugs are used for treatment of ADHD in children?
- Methylphenidate
- e.g. Medikinet, Concerta XL,
Equasym XL, Tranquilyn - Atomoxetine
- Dexamfetamine
- (Lisdexamfetamine is a prodrug of Dexamfetamine)
- Elvanse
Methylphenidate
Medikinet, Concerta XL,
Equasym XL, Tranquilyn, Xagittin XL
Lisdexamfetamine
Elvanse
Which drug treatment is first-line for
children?
- Methylphenidate
If after 6 weeks trial of maximum tolerated dose and still experiencing symptoms switch to 2nd line
Treatment in children 5+
- Methyphenidate
- Lisdexamfetamine/ Dexamfetamine
- Atomoxetine/Guanfacine
Lisdexamfetamine vs dexamfetamine
- Lisdexamfetamine = longer duration of action = larger SE profile
- If pt can’t cope with this switch to dexamfetamine
When would
Atomoxetine or
Guanfacine be used in a child?
If they couldn’t tolerate
Methylphenidate and Lisdexamfetamine or
Dexamfetamine
Which release pattern of drug treatments may be preferable for a child?
- MR
- Same applies for adults
- Reduces the need to take doses in school (or work) due to slow release pattern
When would immediate release preparations be preffered in ADHD?
- During initial dose titration
- When more flexible dosing regimens are required
- Can also be used in combination with MR preps at certain times of day to extend duration of action
Treatment in adults
- Methyphenidate or lisdexamfetamine/ dexamfetamine
* 6 week trial of one of them - if it doesn’t work try the other - Atomoxetine
- Refer to specialist ADHD service
What other drug treatments can be used for treating
ADHD in adults?
- Guanfacine (unlicensed - NOTE: ONLY LICENSED FOR USE IN CHILDREN)
- Bupropion (Zyban)
(Unlicensed) - Modafinil (Unlicensed)
- TCA antidepressants
(Unlicensed) - Venlafaxine (Unlicensed)
When would CBT be considered in adults?
- If the patient is stabilised on drug treatment but still has functional impairment associated with the disorder
OR - There has been no response to drug treatment
unlike most mental health disorders, CBT is done after trying drug treatment
Do ADHD drugs cause weight GAIN or weight LOSS
weight loss
