peds: ADHD Flashcards
Gold standard ADHD txt
stimulant meds (ampthetamines + methylphendiate)
define ADHD
development disorder of inattention + hyperactivity/impulsivity
Worldwide Prevalence of ADHD Is ___
5% (in ALL countries)
are boys or girls more likely to have ADHD?
boys, but Higher number of males may be due to referral bias (rowdy boys)
median age of Dx? what does a younger Dx often mean?
7 yo
- younger Dx is usually a more severe case
Symptoms of ADHD _____ and ______ from childhood to adulthood. Clinicians should consider impact on _____ ?
decline and change consider QOL (i.e. as an adult- difficulty holding a job)
biological cause of ADHD?
overall: biological substrate (not just enviornmental cause)
(extra info: Compromise of “executive center” in frontal lobe Impairment of dopamine and norepinephrine function)
ADHD- affects in adolescence (4)
Poor participation in group activities
Few friends
Vulnerable to antisocial groups (Gangs)
Vulnerable to drug abuse
ADHD affect on parents
stress + lower self-esteem. Increased alcohol/drug use, marital and employment disruption
Increased Lifetime Substance Abuse in what group?
Untreated Adults with ADHD (roughly 2x risk)
smoking and traffic violations- increase with ADHD?
yes!
Dx of ADHD
- Use of parent and teacher behavior rating scales
- Medical and neurological examination and interview of child
- psych eval.
activity in _____ is NOT predictive of ADHD
doctor’s office
DSM V for hyperactive/impulsivity symptoms of hyperactivity and impulsivity must occur _____. What is the time period?
hyperactivity and impulsivity
OFTEN
*Must have 6 or more symptoms for at least 6 months to a degree that is maladaptive and inconsistent with developmental level.
DSM V for inattention symptoms, symptoms of inattention must occur ____ ? time period?
OFTEN
(Careless, Difficulty sustaining attention in activity, Doesn’t listen, loses items etc. )
*Must have 6 + symptoms for at least 6 months that are maladaptive + inconsistent w/ development level
DSM V ADHD (4 criteria to meet)
A: symptoms for 6 months
B: 2 + settings (eg, school and home)
C: Significant impairment: social, academic, or occupational
D: Exclude other mental disorders
what are two particular medical disorders may mimic ADHD?
seizures, sleep apnea
3 part non-pharm mgmt of ADHD
- educational intervention
- counseling
- Behavior management: positive reinforcement strategies
meds for ADHD
Medications: **stimulants, nonstimulants (straterra) , antidepressants, anti-HTNs, alpha adrenergics (guanfacine) , neuroleptics
4 ADRs of stimulants
Appetite suppression;
Insomnia if given in evening
Headache, stomach ache, dysphoria, tics–10% - 20%
Rebound phenomenon
Concern: use of stimulants may increase _____ or _____
motor or vocal tics
but not a problem for most
if on a stimulant, what must be monitored twice a year?
Height and weight
4 signs you should refer ?
- academic difficulties persist- psychological testing
- Parental and family strain - family therapy
- sustained low self-esteem -individual child psychotherapy or CBT
- not responding to meds- child psychiatrist
severe ADR with stratterra (atomoxetine) ?
liver impairment - but studies show the risk if actually low
severe ADR with adderall?
cardiovascular issues
do Current guidelines of AAP recommend cardiac screening or routine EKG before putting someone on stimulant drugs?
no
what can you use for diet mgmt in ADHD?
vayarin
