child and adolescent - mentor & more 1 Flashcards
Children under 5: ADHD
* First-line
ADHD-focused group parent-training
Children under 5: ADHD
* If first-line fails
obtain advice from a specialist ADHD service (tertiary service)
medication for ADHD for any child under 5years
Do not offer medication without a second specialist opinion from an ADHD service
Children and young people (5-18): ADHD
- Provide educational advice and support (1-2 sessions possible)
- Offer ADHD parent training in groups
- Consider medication if significant impairment persists after environmental changes
- Suggest cognitive behavioural therapy (CBT) for young people still significantly impaired despite medication
NICE stance about elimination diet for ADHD
it is against it
when to refer ADHD to cardiology before medicaitons?
- Suggestive cardiac symptoms (fainting, breathlessness, palpitations).
- Sudden death of a first-degree relative under 40 years.
Medication in children and young people (5-18): ADHD
First line
- Methylphenidate or lisdexamfetamine is first-line (try for 6 weeks)
- If above ineffective, consider switching to to the alternative first-line option
- Consider dexamfetamine for those responding to lisdexamfetamine but who cannot tolerate the longer effect profile
Medication in children and young people (5-18): ADHD
Second line
- Offer atomoxetine or guanfacine for those who can’t tolerate methylphenidate or lisdexamfetamine
medication NOT to offer for ADHD without advice from a tertiary ADHD service
- Clonidine treats ADHD in children experiencing sleep disturbances, rages, or tics.
- Atypical antipsychotics may assist ADHD patients with aggression or irritability.
what to do in patients on ADHD Drugs and develop Mania or psychosis
stop ADHD treatment until the episode has resolved
If a person taking stimulants develops tics then what:
- Continuing the medication
- Reducing medication
- Stopping medication
- Swapping to guanfacine , atomoxetine, or clonidine
when to cont. the medication in patients on stimulants who develop tics?
if benefit outweighs risk
when to give guanfacine in patients on stimulants who develop tics?
in children aged 5years and over and young people only
why A drug holiday in ADHD children?
To address concerns about growth restriction
NICE Review on ADHD Drug holiday
Withdrawal from treatment was associated with a risk of symptom exacerbation.
NICE conclusion for drug holiday in ahdd?
- Consider treatment breaks during school holidays for children affected by medications.
- Stimulants can cause minor growth restriction (1-2 cm).
- Growth often normalizes during breaks.
- Monitor for potential larger effects in some cases.
Monitoring of ADHD (children): Weight
- Weight: Every 3 months (under 10 years); every 6 months thereafter.
Monitoring of ADHD (children): Height
- Height: Every 6 months (children and young people).
Monitoring of ADHD (children): Blood pressure
- Blood Pressure & Pulse: Before/after dose change, then every 6 months once stabilized.
Stimulants example in ADHD
METHYLPHENIDATE
LISDEXAMFETAMINE
NON-STIMULANT examples in adhd
Atomoxetine
Guanfacine
Clonidine
Dexamfetamine : Mechanism (hypothesised)
Inhibiting DA (dopamine) and NA (noradrenaline) reuptake
Methylphenidate : Mechanism (hypothesised)
Inhibiting DA and NA reuptake
Lisdexamfetamine: Mechanism (hypothesised)
Prodrug, absorbed by GI tract, converted to dexamfetamine which inhibits the reuptake of NA and DA. Converted by enzymes in red blood cells into dexamfetamine and L-lysine (amino acid). The activation of the prodrug results in longer action and a reduced abuse potential