ADHD (tut 7)

ADHD may display two types of symptoms:

• Inattention

• Hyperactivity/impulsivity

ADHD can be classified as:

• Predominantly inattentive

• Predominantly hyperactive/impulsive

• Combined type

For a diagnosis of ADHD of any classification, at least…………symptoms need to persist for at least……………………..

six symptoms or more for at least six months

For a proper ADHD diagnosis, behaviours must be:

• Onset at age 7 to 12

• Present in two or more settings

• Cause significant impairment to child’s life

• Not associated with another mental disorder

Rating scales of ADHD.

• Conners rating scale-revised

• ADHD rating scale IV

• Vanderbilt ADHD (captures conduct disorders, depression and anxiety, along with ADHD)

• ADHD symptoms rating scale for effects on social functioning

Non-pharmacological management of ADHD involves

1. Behavioral ttt

CBT & behavioral parent training (BPT)

2. Diet & certain herbal supplements (kaiser Permanente/Feingold diet)

3. Combination of essential FA such as ginkgo, biloba, ginseng

Pharmacological ttt involves:

1. Stimulants

(Amphetamines & methylphenidate)

1st line. If failed—→ trial of another stimulant class.

2. Non-stimulants

Atomoxetine 2nd line agent

Bupropion off-label

a2 adrenergic agonists (Guanfacine & clonidine)

TCA

Modafinil & antipsychotics

AAP recommendation for ADHD ttt:

1. Children 4-5 yrs old: 1st line—behavioural therapy. 2nd line—methylphenidate

2. Children 6-11 years old: medication + behavioral therapy

3. Adolescents 12-18 yrs old: medication and consider behavioral therapy

Patient with depression along with ADHD acc. to Vanderbilt ADHD rating scale has first line intervention of:

Psychoeducation to them and their parents, and an individualized education plan (IEP). Stimulants can be considered.

If a second trial of a different stimulant class doesn’t show man efficacy, then combination therapy of stimulant and ……………….can be tried.

a2 agonist such as clonidine or guanfacine.

If abuse of stimulant is suspected in adult patient, what should be done?

• Consult physician of prescription refill and ADHD diagnosis

• Switch to less abusable stimulant like the prodrug lisdexamfetamine or MPH transdermal patch.

• Switch to atomoxetine, venlafaxine or modafinil

Stimulant likely to cause psychotic symptoms (hallucinations, paranoia) due to dopamine increase:

Methylphenidate.