ADHD Hays Flashcards
ADHD
ADHD is a common neurodevelopmental disorder that may affect
about 7%–8% of children and 2.5% of adults
ADHD symptoms
triad of symptoms:
impulsivity
inattention
hyperactivity
ADHD subtypes
hyperactive-impulsive
inattentive
combined
The majority of children with ADHD
have a combined type with symptoms of inattention as well as hyperactivity and impulsivity
Girls
have a higher prevalence of the inattentive subtype
Boys
have a higher prevalence of the hyperactive subtype
Symptoms
Although symptoms begin in early childhood, they can diminish between ages 10 and 25 years
hyperactivity
declines quickly
impulsivity and inattentiveness
often persist into adolescence and adulthood
ADHD may be combined with
mood disorder in approximately 20% of patients,
conduct disorders in 20%,
oppositional defiant disorder in up to 40%.
Up to 25% of children with ADHD seen in a referral clinic have tics or Tourette syndrome. Conversely, well over 50% of individuals with Tourette syndrome also have ADHD.
ADHD Medications
Stimulant medications (methylphenidate, dextroamphetamine, mixed amphetamine, and lisdexamfetamine) are available in short and long-acting preparations and in tablet, capsule, liquid, and dermal patch forms.
rapidly acting
Alternative medications for the treatment of
ADHD
extended release guanfacine
atomoxitine - non-stimulant, takes 2-4 weeks for effect
Stimulants
enhance both dopamine and norepinephrine neurotransmission
side effects of methylphenidate and dextroamphetamine
appetite suppression and resulting weight loss, as well as sleep disturbances
Stimulants may exacerbate
psychotic symptoms
motor tics
Cardiovascular effects of stimulant medications
do not appear to increase the risk of sudden death over the risk in the general population, especially in children without any underlying risk
before stimulant medications is prescribed
history of syncope, palpitations, chest pain, and
family history of sudden death prior to age 30 that may predispose a
child to sudden death
Stimulant products and atomoxetine
should generally not be used in patients with serious heart problems or in those for whom an increase in BP or HR would be problematic
The FDA has recommended that patients treated with
ADHD medications
should be monitored for changes in HR or BP.
ADHD comorbid disorders
anxiety, sleep disorders, and learning disabilities
ADHD - neurologic disorder
makes the symptoms difficult for the child to control
behavior modification techniques
should include structure with consistency in
daily routine, positive reinforcement whenever possible, and timeout for negative behaviors
individual counseling is beneficial
in alleviating poor self-esteem, oppositional behavior, and conduct problems
Stimulant medications
Seventy to 90% of children with normal intellectual abilities respond well to stimulant medications
Which of the following drugs that are used to treat attention deficit
hyperactivity disorder (ADHD) is not classified as an amphetamine/stimulant?
A) Dexmethylphenidate (Focalin XR)
B) Mixed salts of amphetamine (Adderall)
C) Methylphenidate (Ritalin)
D) Atomoxetine (Strattera)
D) Atomoxetine (Strattera)
Atomoxetine (Strattera) Strattera is classified as a norepinephrine reuptake inhibitor. It is not a stimulant or an amphetamine. Strattera is contraindicated
during/within 14 days of taking a monoamine oxidase inhibitor (MAOI) in patients with narrow-angle glaucoma or a heart disorder that will worsen with increases in blood pressure or heart rate, or in those with pheochromocytoma.
Children and teenagers should be monitored for suicidal thoughts/plans.
