Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

SPRING16 N833 Adv Pedi > ADHD > Flashcards

ADHD Flashcards

1
Q

What are some sources of school failure?

A
  • Health issues
  • Emotional issues
  • Learning issues
  • Attention issues

*try to distinguish where coming from – cognitive ability specific to subject? auditory or visual? Emotional changes? Etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the risks to untreated adhd?

A

cascade of negative consequences: poor self esteem –> poor academic performance –> risk taking, substance abuse, etc. –> poor employment options, poor health outcomes, poor relationships

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

3 characteristics of adhd

A
  1. inattentiveness
  2. hyperactivity
  3. impulsivity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Definition / diagnostic criteria ADHD

A
  • Interferes w/functioning across settings: home, school, work
    • Behaviors > signifcant than peers
  • Triad of behaviors beyond range of accepted for “normal”
  • At least 6 months
  • Symptoms before 12 years of age
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

3 subtypes of adhd

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Neurobiology: structural differences associated w/adhd

A

Chronic neurobehavioral disorder

smaller frontal lobes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Neurobiology: functional differences associated w/adhd

A
  • Lower blood flow
  • Response to meds
  • Alteration of neurochemical transmission

Chronic neurobehavioral disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

ADHD: genetics vs environment

A
  • Very high incidence in twin studies
  • 75% variance in phenotype is genetic, not environmental
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Specific genes associated with adhd

A

•Dopamine receptor gene

–Cognition, memory, exploratory behaviors

•Dopamine transport gene

–Site of action of stimulants

•Similar genes linked to other mental health issues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

prenatal/parinatal factors associated with adhd

A
  • Pregnancy complications
  • Prematurity/SGA
  • Hypoxemia
  • Hypoperfusion: – low cerebral blood flow associated with increased dopamine receptor availability in adols with ADHD
  • Maternal smoking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

psychosocial factors associated with adhd

A
  • Maternal depression
  • parenting skills/stress
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

biologic factors associated with adhd

A
  • Lead exposure: even low lead levels showed hyperactivity in preschoolers
  • Iron deficiency
  • Obstructive sleep apnea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

diet factors associated with adhd

A
  • food additives
  • sugar

*may be triggers in genetically susceptible child - make better or worse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

prevalence of adhd in u.s.

A

~11%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Preschool age: prevalence, type, male vs female

adhd

A
  • Prevalence: 2-5%
  • Type: 48% hyperactive/impulsive
  • 1:1 female to male
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

School age: prevalence, type, male vs female

adhd

A
  • Prevalence: 3-11%
  • Type: many combined, many inattentive/impulsive
  • 1:4 female to male
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

High School age: type, diagnosis

adhd

A
  • Type: more inattentive, esp girls
  • Diagnosis: ?? other DOs- ODD, CD, “adolescence”, also difficulty w/APA criteria (before 12y)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Characteristics of inattentiveness in ADHD

A
  • Easily distracted
  • Poor listening skills
  • Poor attention to details
  • Forgetful
  • Disorganized
  • Poor sustained attention to play or tasks
  • Fewer activities requiring sustained attention
  • Loses items
  • Needs redirection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Characteristics of hyperactivity in ADHD

A
  • Most troublesome for preschoolers/early school age
    • “On the go”, “Driven by a motor”
    • Driven to interact with the environment (restlessness in adolescents)
    • Unable to remain seated, even briefly
    • Difficulty settling to play
    • Fidgety
    • Excessive talking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Characteristics of impulsivity in ADHD

A
  • Takes risks
  • Disregards physical boundaries
  • Unable to cooperate with peers or adults
  • Interrupts
  • Difficulty waiting turns
  • Unable to delay gratification, even briefly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Characteristics of preschoolers w/ADHD

A
  • Lack of rhythmicity
  • Poor adaptability
  • Sleep disturbances
  • Moodiness/irritability
  • Demanding of attention
  • Slower language development
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Preschoolers: behavioral risks associated w/adhd

A
  • Poor impulse control
  • Expelled from preschool settings
  • More disruptive
  • Less cooperative
  • Less opportunity to develop social skills
  • Increased risk of injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Preschoolers: Social risks associated w/adhd

A
  • Problematic parent/child relationship
  • Family stress
  • Limited activities /experiences
  • Focus on discipline
  • Poor social skill development
  • 89% - significant impairment in at least one relationship

Intrusive, in your face, no boundaries, first in line, taking turns, sharing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Preschoolers: academic risks associated w/adhd

A
  • Poor pre-academic skill development
  • Delayed emergent literacy
  • Parents don’t extend and expand language
  • Disrupted phonological awareness
  • Lower scores
  • Working memory
  • Planning
  • Cognitive flexibility
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Preschoolers: comorbidities associated w/adhd

A
  • 35-50% Oppositional Defiant Disorder
  • 15% Anxiety
  • 13% Depression
  • 19% >1 comorbidity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Challenges to diagnosing adhd in preschoolers

A
  • high energy level: may be nl
  • non-compliant behavior
  • day-to-day variability in behavior
  • situational response to environment
  • Neurologic immaturity
  • Child-environment mismatch
  • Adult expectations of behavior: may be unrealistic for age
  • Co-morbidity: e.g., dvptl problems
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

General Characteristics of adhd in school-age children

A
  • Issues with peers
    • Emotionally immature
    • Prefer younger children or adults
  • Emotional lability
  • Procrastination
  • Disorganization
  • Distractibility
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Characteristics of adhd in EARLY school-age children

boys vs girls

A

Boys: high activity level

Girls: “good”, no trouble

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Characteristics of adhd in LATER school-age children

boys vs girls

A

Boys: increasing oppositional behavior

Girls: more social, talkative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

risks for school-age child with adhd

A
  • Family stress
  • Family relationships
  • Social issues
  • Academics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

challenges in diagnosis of adhd in school age children

A
  • Normal development
  • Learning disabilities
  • Medical issues
  • Comorbidities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Course of adhd in adolescents

A
  • Previously
    • Maturational lag
    • Outgrown in adolescence
  • Currently
    • 65% persist with symptoms at least into adolescence, often adulthood
    • Some not diagnosed until adolescence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Characteristics of adhd in adolescents

A
  • Hyperactivity declines
  • Inattentiveness more obvious
  • School struggles
    • Multiple teachers
    • Multiple expectations
  • Cognitive demands increase
    • Memory
    • Higher level thinking
  • Independence expected
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Comorbidities associated with adhd in adolescents

A

ODD, anxiety, depression, substance abuse DO, personality DO, learning disabilities**

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Characteristics suggestive of ODD or conduct DO in adolescents

A
  • Argumentative
  • Negative
  • Easily frustrated
  • Conflicts at school
  • School refusal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Characteristics suggestive of anxiety in adolescents

A
  • Restlessness
  • Difficulty concentrating
  • Irritability
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Characteristics suggestive of depression in adolescents

A
  • Social isolation
  • Irritability
  • Boredom
  • Reckless behavior
  • Academic underachievement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Principles of assessment of adhd

A
  • Multiple sources
  • Good tools
  • Recurring themes
  • Connections to school and life outside of school
  • Profile of strengths and weaknesses
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Components of ADHD assessment: History

A
  • History
    • Past medical
      • Birth
      • Chronic illness
      • Acute illness
      • Trauma
      • Development
  • Social history
    • Family stressors
    • Out-of-home care
    • Family structure
  • Family Medical
    • Genetics
    • Sibs, cousins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Components of ADHD assessment: PE

A
  • Affect/emotional response
  • Dysmorphic features
  • Behavior
  • Communication skill
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Components of ADHD assessment: Medical Screenings (as indicated)

A
  • Sensory
  • Lead
  • Iron
  • Thyroid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Components of ADHD assessment: Developmental / neurodevelopmental screening

A
  • Language/linguistics
  • Memory
  • Personal-social
  • Motor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Why are parent interviews important in adhd?

A
  • Home less structured
  • Different expectations
    • Appropriate
    • Inappropriate
  • Unaware of full range of behaviors
    • School behavior
    • Social interactions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What to look for in interview w/preschool teacher: adhd

A
  • Normative perspective
  • Structured and unstructured samples of behavior
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Important concepts w/elementary/HS teacher interview: adhd

A
  • May have no knowledge of outside classroom behavior
  • poor interrater reliability among teachers
  • Parent-teacher agreement =74%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Characteristics of students perspectives on adhd symptoms

A
  • Under report symptoms
  • Under rate level of impairment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Who should be involved in adolescent interviews for adhd and why?

A
  1. Adolescent alone
  • Confidentiality
  • Concerns
  • Perception of school and family issues
  • Sensitive topics
    • Use of ETOH, drugs
    • Driving habits
  1. Parents alone
  • Perceptions of issues
  • Contact with school
  • Approaches tried
  • Expectations from evaluation
  1. Adolescent and parents together
    * Shared concerns?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Rating scales in adhd: why, disadvantes, types

A
  • Attempt to objectify behavior
  • Some normed to age and gender
  • Impressionistic, subjective
  • Some specific to ADHD, others to range of emotional/behavioral problems
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Specific provider rating tools for adhd, recommended

A
  • Vanderbilt (AAP)
    • ADHD
    • Comorbidities
  • Connors
  • McCarney (ADDES) short / long forms
  • Brown ADD Diagnostic Form for Adolescents – Revised
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Self-assessment tools for adhd

A
  • Pediatric Symptom Checklist
  • ANSER Self-Report ( >9 years)
  • Brown ADD Scales for Adolescents
  • Conners-Wells Adolescent Self Report Scale
51
Q

other adhd assessment tools

A
  • Early Childhood Inventory IV
  • SNAP-IV
  • Child Behavior Checklist
  • Preschool Age Psychiatric Assessment
  • Behavior Assessment System for Children
  • ANSER system
52
Q

academic information used to assess adhd mgmt

A
  • Report cards
  • School progress- teachers’ comments
  • Standardized testing
  • Psychoeducational testing
  • Neuropsychological testing
53
Q

Differentials to adhd for preschoolers: medical

A
  • Normal exuberance
  • Medical disorders
    • Seizures
    • Significant lead poisoning
    • Sensory deficit
    • OSA
    • Iron deficiency
    • Chronic OM
54
Q

Differentials to adhd for preschoolers: developmental DOs

A
  • Language delay
  • Fragile X syndrome
  • Intellectual disability
  • Autism spectrum
  • FAS
55
Q

Differentials to adhd for preschoolers: psychiatric DOs

A
  • Depression
  • Anxiety
  • ODD
56
Q

Differentials to ADHD for school age and adolescents

A
  • Learning disability
  • Mental health issues
  • Chronic conditions
  • Sensory deficit
  • Parental expectations
57
Q

What are the components of learning, according to PRK’s slides?

A
  • Attention
    • mental energy controls
    • processing controls
    • production controls
  • Temporal - sequential ordering
  • Spatial ordering
  • Memory
    • short term
    • active working
    • long term

Language

  • receptive
  • expressive
  • written

Neuromotor functions

  • gross motor
  • fine motor

Social Cognition

Higher order cognition

Levine, M_, A Mind at a Time_

58
Q

Components of a student profile of a child w/adhd

A
  • Strengths
    • What works best?
    • Affective resources
    • Coping styles
  • Needs
    • Where does the breakdown happen?
    • What makes it better?
  • Environmental influences
  • How can school facilitate success?
  • Affinities
  • Motivators
59
Q

Inattentive

Hyperactive/impulsive

combined

A
60
Q

What are the goals of adhd mgmt?

A

Develop self-regulatory behaviors:

  • maintain self esteem
  • develop social skills
  • foster learning behaviors
  • improve family functioning
61
Q

General mgmt guidelines

A
  • Chronic condition
    • Long term management
    • Ongoing evaluation of treatment options
    • Careful planning
    • Support for child, caregivers, teachers
  • Identification of target outcomes
62
Q

mgmt of adhd: education of parents, dhild, adolescent

A
  • Demystify
    • Chronic condition
    • Symptoms manageable
    • Outcomes good
  • Destigmatize
    • Not associated with intelligence
    • Not associated with being “bad kid”
63
Q

Environmental mgmt of adhd

A
  • Safe, appropriate boundaries
  • Sense of order and control
  • Consistent expectations/routines
  • Active involvement
  • Collaboration and cooperation
  • Reduced stimuli – TV, music, and computer, phones
64
Q

behavioral mgmt training for adhd: goals

A
  • Goals
    • Decrease core symptoms
    • Improve parent-child interaction
    • Improve peer interaction
    • Decrease oppositional behaviors
    • Generalize to other settings
  • Much research about use with preschoolers

  • difficult for disorganized families to implement*
  • Focus on immediate issues*
65
Q

Components of behavior mgmt for adhd

A
  • Positive reinforcement
  • Token system
  • Time out
  • Response contingency: withdrawal of attn
  • Limit setting
  • Appropriate commands and reprimands
  • Group social skills
  • Cognitive/ behavioral self control training
  • Anger management
  • “report card”
  • Overcorrection
  • Minimize negative feedback
66
Q

Considerations when initiating pharm mgmt

A
  • Seldom should be only treatment but often is only treatment
  • Consider co-morbid conditions
  • Informed consent/assent of adolescents
  • Risk/benefits
67
Q

Monitoring pharm mgmt of adhd

A
  • Side effects: occurrence, monitoring
  • Toxicity: abuse, cardiac, liver
  • Periodic assessment
68
Q

What is the most commonly used category of medications for adhd?

A

stimulants (1.5 million)

69
Q

What is the most successful category of medication used for adhd?

A

stimulants: 80% will improve

70
Q

What areas do stimulants improve in adhd?

A
  • concentration (mental energy, focus and processing controls)
  • behavior (decreased impulsiveness)
  • socialization (reduced activity and intrusiveness)
71
Q

MOA of stimulants for adhd

A
  • Enhance neurotransmitter in brain pathways involved in inhibition
  • Activate brain stem arousal
72
Q

How to dose stimulants

A

until effectiveness w/o side effects

73
Q

What are the categories of stimulants?

A

methylphenidates, amphetamines

74
Q

Methylphenidates used for adhd

A
  • Ritalin ( S & L): capsule you can empty
  • Focalin ( S & L): isomer of ritalin (5mg=10mg of ritalin)
  • Methylin ( S & L )
  • Metadate ( S & L): capsule you can empty
  • Concerta ( L): must be swallowed whole
  • Daytrana – patch (L)
  • Quillivant XR 25mg/5ml (L): liquid
75
Q

Stimulant that has less abuse potential

A

Vyvanse - needs to get into stomach to work, less abuse potential

76
Q

Which stimulant is good for afternoon overactivity?

A

Methadate

77
Q

amphetamines used for adhd

A
  • Dexedrine (S & L)
  • Adderall ( S & L)
  • Vyvanse ( L)
78
Q

Characteristics of short-acting stimulants

A
79
Q

Characteristics of long-acting stimulants

A

E.g., concerta is good for older students - steady period of action, ~12h duration

80
Q

What is unique about Daytrana?

A
  • Apply 2 hours before needed on alternating hips (can be annoying)
  • Remove in 9 hrs.
  • Prior use of stimulants recommended
  • Same safety/ risk profile as oral
81
Q

What is the newest stimulant and how is it dosed?

A
  • Quillivant 25/5ml
  • Liquid
  • Long acting
  • Start at 20mg ?!
  • Same safety and SE profile as others
82
Q

Potential side effects of stimulants

A
  • Appetite suppression
  • Weight loss
  • Headaches
  • Increased heart rate
  • Increased blood pressure
  • Tics
  • Delayed sleep onset
  • Rebound phenomenon
  • Growth suppression ? unclear data
  • Moodiness
  • Sadness
  • Lowering of seizure threshold
83
Q

How to manage appetite suppression/wt loss on stimulants

A

eat breakfast before medication

If on ER, will happen around lunch. They can have snacks before school.

amphetamines seem to have more appetite suppression

84
Q

What are some cautions with stimulants

A
  • Significant anxiety, tension, agitation
  • Allergies to components
  • Glaucoma
  • Current or recent use of MAOI
  • Motion or verbal tics or family history
  • Structural cardiac defects
  • Abuse potential
85
Q

Is routine cardiovascular monitoring needed before starting stimulants?

A

Previously it was

in 2008, AAP recommended no ECG: no increased risk of SCD and questionable S/S of ECG in predicting SCD

86
Q

When should CV monitoring be done before starting on stimulants?

A

+ FMH or + personal history of cardiomyopathy, WPW, arrhythmia, long QT, other functional, structural heart issues

**Also screen adopted kids who don’t know family Hx

87
Q

What CV history do you need before starting stimulants?

A
  • Careful evaluation before starting stimulants
  • Child’s history
  • Family medical history
    • Early events
    • Cardiomyopathy
    • Long QT syndrome
88
Q

What CV f/u is needed on stimulants?

A
  • Vital signs
  • Symptoms referable to CV system- syncope, palpitations ( butterfly in my chest), SOB, “heart pain”
89
Q

State of the evidence on medicating preschoolers for ADHD

A
  • Previous studies in preschoolers
    • Few
    • Short duration
  • Increase in off-label use of stimulants (3-fold increase during 90s)
    • Many medications not approved for <6 year olds
    • Few long term outcomes or safety data
  • Newer study: Pre-school adhd treatment study (pats)
90
Q

What is PATS?

A
  • Pre-school adhd treatment study (pats):
  • a multi-site randoized control trial (3-5.5yrs)
  • Components: parent training, medication trial
  • Results: parent training alone not helpful, 85% with good response to methylphenidate
91
Q

When are adhd medications recommended for preschoolers, and which ones, according to aap?

A
  • IF careful assessment and severe symptoms
  • Use methylphenidate
  • start low, titrate up to effectiveness w/o SEs (tmg)
  • Use short acting throughout day (TID)
92
Q

Impact of stimulants on developing brain, preschoolers

A

no long term safety / efficacy impact

93
Q

SEs of stimulants on preschoolers?

A
  • Question of growth suppression
  • Crabbiness, irritability, fatigue – diminished over time
  • Worry and anxiety -persisted over time
  • Sleep and appetite issues- persisted over time
94
Q

Are dependence and abuse issues when prescribing stimulants?

A

•Dependence

–Abused at high doses

–Possibly psychological

  • Abuse
  • Marketable
  • SAD: Conflicting reports

–Well managed students, less SAD

–Potential in non-prescribed students for SAD

95
Q

Concerns with energy drinks and stimulants?

A

Synergy!

96
Q

When might you Rx strattera?

A

Not responding to stimulants or high abuse potential

–Mood stabilizing effect if comorbidity

97
Q

What is Strattera?

A

–First non-stimulant for ADHD

–Norepinephrine reuptake inhibitor

98
Q

When should effects of Strattera be seen?

A

–2-6 weeks before effects seen

–24 hour period of action

99
Q

SEs of Strattera

A

–GI upset –

  • High protein foods
  • Start low dose (.5mg/kg)titrate upwards (1.2mg/kg)

–Liver toxicity

  • Dark urine
  • Itchy skin
  • Jaundice
  • RUQ pain
100
Q

When is Intuniv recommended?

A

Non-stimulant! Good for high activity levels, issues w/stimulants

Recommended:

  • Core ADHD symptoms plus irritability, temper regulation
  • Intolerant of stim, tics or sleep issues
  • 6-17 year olds
101
Q

Is Intuniv approved for use w/stimulants?

A

yes!

102
Q

How should Intuniv be taken?

A
  • 1,2,3 and 4 mg tablet qd
    • Swallow only
    • No fatty foods
    • Effectiveness ~2-3 weeks
  • Taper by 1 mg q 3-7 days
103
Q

Intuniv MOA

A

Interacts with receptors in prefrontal cortex

guanfacine - a BP med

Central alpha-2 adrenergic agonist

104
Q

Side effects of Intuniv

A
  • Fatigue, drowsiness
  • Lowers blood pressure:
    • Lightheadedness, syncope
  • GI: Nausea, stomach pain, constipation, appetite, dry mouth
  • Neuro: Irritability, headaches
105
Q

Monitoring of Intuniv

A

BP and HR @beginning and with every ↑ and then q med check

106
Q

What is the newest non stimulant for adhd?

A

Kapvay / Clonadine

107
Q

MOA of Clonadine

A

MOA unknown in ADHD

May involve prefrontal cortex activity like Intuniv

108
Q

Indications and dosing for Kapvay?

A
  • Age indication: 6-17 years old
  • 0.1- 0.4 mg/day (bid)
  • Swallow whole
  • Taper over 3-7 days
  • Mono or adjunct tx with stimulants!
109
Q

SEs of kapvay

A
  • Similar to Intuniv
  • Bradycardia
  • Somnolence, etc.
110
Q

Intuniv vs kapvay

A

BID as opposed to Intuniv which is QD. Also good for hyperactivity.

Like Intuniv, Combine w/stimulant for attention

111
Q

What needs to be discussed when initiating medication for adhd?

A
  • Clear discussion parent and patient
  • Needs
  • Expectations
  • Targeted outcomes
  • Side effects
  • FMH
  • Personal history
  • Plan for follow up
  • Contract
112
Q

Considerations when choosing a medication for adhd?

A
  • Subtype
  • Issues with “quality of life”
  • Short acting vs long acting
  • Delivery method
  • Start low, titrate up
113
Q

cautions when Rxing stimulants

A
  • Controlled substances
    • DEA number, 1mo supply, not called in
  • High risk behaviors
  • Other meds/drugs
  • Caffeine and energy drinks
  • Selling, sharing, abusing
  • Parental monitoring of meds
114
Q

When / how to follow up after initiating adhd meds

A
  • Phone check: 2 weeks
  • Office visit: 1 month
  • Effectiveness
  • Side effects
  • Need for dose change or type or class change
  • HR, BP, weight, neuro
115
Q

How should regular f/u be conducted w/adhd on medication?

A
  • Appropriate, effective, well tolerated dose
  • See q 3 months
    • School and home info
      • Progress, efficacy, concerns
    • VS, HT, WT, neuro
    • Review expectations
  • Rescreen with Vanderbilt F/ U forms
  • Adjust management as needed
116
Q

Why might med aherence be decreased in teens?

A
  • 48% adolescents stop meds
  • Deny problem
  • Issues of independence
  • Parents less willing to insist or administer
  • 4.5 Rx filled/year!!!
117
Q

What might increase adherence in teens?

A
  • Better self concept
  • Stable family
  • Internal locus of control
  • Increased motivation
  • Simplified medication regimes
  • Fewer adverse effects
  • Use of motivational interviewing
118
Q

Some CAM / alternative approaches to adhd?

A
  • Dietary changes
    • Additives
    • Sugars
    • Herbs
    • Omega 3 Fatty Acids
    • Zinc
    • Iron/vitamins
  • Relaxation training
  • Cerebellar training
  • Neuromapping
  • Optometry
  • Exercise
  • Outdoor activity

  • Chamomile and valerian ok for restlessness, concentration and sleep issues. Kava kava has adverse effects on CNS with chronic use*
  • No support of megadose of vits/minerals – should treat iron deficiency*
119
Q

options for educational intervention in adhd?

A
  • Individuals with Disabilities Education Act (funding)
    • Services for disabilities that affect educational performance
  • 504 Sec of Rehabilitation Act ( no $)
    • Prohibits discrimination against anyone with disability
    • Regular class, spec services, (FAPE)
    • can be very creative to meet needs, motor breaks, etc
120
Q

What is a 504 plan?

A
  • Provides accommodations, modifications in regular classroom
    • Preferential seating
    • Extended time
    • Modified assignments
    • Alternative test setting
    • Overflow activity
    • Motor breaks
121
Q

What is an individualized education plan (IEP)?

A
  • Legal document (IDEA)
  • Updated annually at Planning and Placement Team (PPT)
  • Resource room
    • Resource support
    • Remedial help
    • Tutorials
    • Study skills training
    • etc.
122
Q

Components of F/U for adhd

A
  • Criteria for efficacy
    • Educational
    • Behavioral
    • Social
    • Pharmacologic
    • Family
  • Communication
    • Parents
    • Teachers
    • Students
    • Other professionals
      • Phone
      • Office visits
      • Repeat checklists/rating scales
123
Q

Outcomes of effective assessment and mgmt?

A
  • Improved self esteem
  • Improved learning outcomes
  • Improved family harmony
  • Improved social skills
  • Improved educational/
  • vocational opportunities
124
Q

Pediatrics: KAS from subcommittee on adhd

A

KASs:

1 – The PCC should evaluate for ADHD if 4-18yo w/academic or behavioral sx of inattention, hyperactivity, impulsivity (B)

2 – DSM-IV (now 5) criteria should be met for Dx. Info primarily from parents/guardians, teachers, other school and mental health clinicians involved in child’s care. R/O alternative cause (B)

3 – PCC should assess for coexisting conditions (anxiety, dep, ODD, CD, learning/language DO, neurodvptl do, tics, OSA) (B)

4 – PCC to recognize ADHD as chronic = special health care needs. Follow chronic care model and medical home (B)

5 – Tx varies by age. PCC recs:

  • Preschool (4-5yo): EB parent and/or teacher administered behavioral tx as 1st line (A), and Rx methylphenidate if no significant improvement and mod-severe continuing disturbance in child’s function. If EB behavioral tx not available, weigh risks of meds vs delay in tx (B)
  • Elementary (6-11yo): FDA approved med (A) and/or EB behavioral tx (B), preferably both. Evidence strong for stiulants, sufficient for atomexetine, ER guanfacine, ER conidine (in that order). The school, program, or placement is part of any tx plan.
  • Adolescents (12-18yo): FDA approved meds w/assent of adolescent (A), and maybe behavioral tx (C), preferable both

6 – titrate doses of meds for adhd to achieve maximum benefit w/minimum adverse effect (B)

SPRING16 N833 Adv Pedi (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions