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AD/HD General Medical Information

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Title: AD/HD General Medical Information


1
AD/HD General Medical Information
  • Mary Margaret Dagen, M.D.
  • Westshore Family Medicine
  • April 24, 2013

2
AD/HD- Definition
  • 6 or more symptoms of inattention for at least
    6mos to a degree that is inconsistent
    w/developmental level
  • 6 or more symptoms of hyperactivity-impulsivity
    for at least 6mos that is inconsistent
    w/developmental level
  • Symptoms present before age 7
  • Impairment from symptoms present in 2 or more
    settings
  • Clinically significant impairment in social,
    academic, or occupational functioning
  • Symptoms do not occur exclusively in another
    mental disorder

3
AD/HD- Definition
  • Inattention
  • Fails to give close attention to details or makes
    careless mistakes
  • Difficulty sustaining tasks/activities
  • Does not listen when spoken to directly
  • Does not follow through on instructions or
    complete tasks
  • Difficulty organizing tasks/activities
  • Avoids, dislikes, reluctant to engage in tasks
    that require sustained mental effort
  • Easily distracted by extraneous stimuli
  • Forgetful in daily activities

4
AD/HD- Definition
  • Hyperactivity
  • Fidgets with hands/feet or squirms in seat
  • Leaves seat in classroom or other situations in
    which remaining seated is expected
  • Runs about or climbs excessively in situations in
    which its inappropriate
  • Difficulty playing or engaging in leisure
    activities quietly
  • Talks excessively
  • Often on the go or acts as if driven by a
    motor

5
AD/HD- Definition
  • Impulsivity
  • Difficulty awaiting turn in games or group
    situations
  • Blurts out answers to questions before they have
    been completed
  • Interrupts or intrudes on others

6
AD/HD- Epidemiology
  • 16 increase in diagnosis since 2007
  • 3.7 children in U.S. have been diagnosed
  • Boys are more likely to be diagnosed (13.2 boys
    vs 5.6 girls)
  • Rates are increasing in teens compared to young
    children

7
AD/HD- Diagnosis
  • Learning disorders? 50 those diagnosed with ADHD
    have co-morbid learning disabilities
  • Oppositional defiant disorder? starts before age
    8. lose temper, argue, refuse to follow rules,
    deliberately annoy
  • Conduct disorder? aggression towards others,
    violations of rules/laws
  • Mental disorders? anxiety, depression

8
AD/HD- Diagnosis
  • Medical exam
  • Evaluate hearing vision
  • Ratings scales checklists
  • Conners Parent Teacher rating scale

9
AD/HD- Diagnosis
  • Conners rating scale

10
AD/HD- Treatment
  • Stimulants (Ritalin, Adderall, Concerta,
    Daytrana, Focalin, Vyvanse, etc)
  • Stimulates CNS (brain) activity by blocking
    reuptake increases release of norepinephrine
    dopamine
  • Side effects? decreased appetite, insomnia,
    anxiety
  • 70-80 children respond positively to these

11
AD/HD- Treatment
  • Non-stimulants (Strattera, Intuniv, Tenex,
    Kapvay, Wellbutrin, etc)
  • Most still affect norepinephrine system, but at a
    different level so they are not directly
    stimulating
  • Less side effect profile

12
AD/HD- Treatment Guidelines
  • Preschool (4-5yo) behavioral therapy is 1st
    line. If this doesnt provide significant
    improvement, trial of stimulant
  • Elementary (6-11yo) stimulants are 1st line,
    behavioral therapy
  • Adolescents (12-18yo) medications behavioral
    therapy

13
AD/HD- Behavioral Therapy
  • Create routine
  • Organization
  • Avoid distractions
  • Limit choices
  • Change interactions to brief explanations
  • Use goals w/rewards
  • Discipline
  • Help child discover a talent

14
AD/HD- Alternative Therapies
  • Screen time diet? no direct relation
  • Feingold diet- sensitivity to dietary salicylates
    artificially added colors/flavors/preservatives?
    no relation
  • Supplements? essential fatty acids,
    glyconutritional supplements, vitamins, amino
    acids, Ginko biloba, herbals
  • Sensory integration? not specific to AD/HD
  • Interactive Metronome training? promising
  • Cerebellar training, anti-motion sickness, yeast
    infections, neurofeedback, chiropractic, thyroid,
    lead? no direct relation to improvement

15
AD/HD
  • www.cdc.gov
  • www.help4adhd.org
  • American Psychiatric Association
  • American Academy of Family Physicians
  • American Academy of Pediatrics

16
AD/HD
  • QUESTIONS??
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