Complete List of Terms and Definitions for ADHD
| Terms | Definitions |
|---|---|
| What is the prevalence of ADHD? | 3-4% |
| What environmental/psychological factors may be involved? | lead, disruptive househould, abuse, neglect |
| True or False Absorption of metadate is affected by food in stomach | True |
| what % of grade school children have ADHD? | 20% |
| True or False Concerta is not affected by food | True |
| Dx Recommendation #3 | The assessment of ADHD requires evidence obtained directly from parents or caregivers regarding the core symtpoms of ADHD in various settings, age of onset, duration of symtpoms and degree of functional impairment |
| What is ADHD | a family of chornic neurobehavioral disorder that interfere with and indiviudals ability to regulate activity, inhibit behavior, and attend to task in developmentally appropriate ways |
| RX recommendation 1 | PCP should esablish a treatment program that recognizes ADHS as a chronic condition. |
| what characterizes the adult w/ADHD? | more problems w/concentration than w/hyperactivity. may have other behavioral problems such as: labile mood, disorganization, bad toleration of stress, and impulsivity. co-morbid conditions w/ADHD: bipolar, depression (poor self image), anxiety disorders, substance abuse, personality disorders, tourette's, and OCD. |
| How many settings must symptoms of ADHD be present in for a diagnosis? | Two or more |
| Which nonstimulant medication is approved for ADHD | Atomoxetine (Strattera). a selective norE reuptake inhibitor, begin slower than recommended dose due to sedation, Rports of GI side effects |
| How do drugs for ADHD work? | by enhancing catecholamine transmission in the prefrontal cortex |
| what age is the cut off point for determining if a pt has ADHD vs just being a kid? | 7 y/o |
| What are the most common comorbid disorders with ADHD and their prevelance rates? |
25% Learning disabilities 25% anxiety 50% ODD/CD 9-40% Depressive D/O |
| At what age does DSM IV state symptoms of ADHD must be present before? | Age 7 |
| What are the first line treaments for ADHD | Methyphenidate and Amphetamines |
| What is the DSM-IV criteria for ADHD | see article on diagnosis |
| Rx Recommendation #2 | The treating PCP parents and child in collaboration with school personall, should specify appropriate target outcomes to guide management |
| How can ADHD be treated? | Commonly treated with medications such as stimulants like methylphenidate and newer, nonstimulant drugs. |
| how do ADHD and bipolar compare? | similar: hyperactive w/mood swings. difference: mood swings w/ADHD are not as prolonged. |
| what characterizes the symptoms of ADHD? | they involve both inattention and motor hyperactivity. they interfere w/regular school and home life routines (2 different settings). |
| what characterizes inattention in a child vs adult ADHD pt? | *child: difficulty paying attention to details, may not follow all you say, doesn't usually complete homework, loses things, forgetful. *adult: lots of things are started (not finished), may not follow everything you say, difficulty w/multiple step projects, awareness of losing things (may create routines to compensate), forget appointments, social commitments, work deadlines. |
| how do ADHD and major depression compare? | similar: poor concentration, problems w/memory and task completion. difference: depression has sleep and appetite problems as well as anhedonia. |
| What are the four classifications of ADHD? |
ADHD Combined type ADHD Predominantly Inattentive type ADHD Predominatly hyperactive-impulsive type ADHD NOS |
| What is the mechanism of action of atomoxetine? | blocks NE reuptake transporter |
| Name 4 areas of the brain that are involved in ADHD |
Prefrontal cortex Temporal cortex Parietal cortex Cerebellum anterior cingulate basal ganglia |
| Describe the mechanism of action for psychostimulants used in the treatment of ADHD. |
block dopamine and norepinephrine reuptake transporters and release dopamine from presynaptic storage vesicles Also weakly stimulate the release of stored norepinephrine |
| Dx Recommendation #1 | In a child 6-12 years old who presents with inattention, hyperactivity, impulsvitity, academic underachievement, or behavior problems, initiate an evaluation for ADHD |
| How has ADHD been correlated with brain volume? | Studies increasingly are finding correlations between ADHD and differences in brain volume or function. Smaller volume and reduced activity are often observed in prefrontal cortical-striatal-cerebellar circuits, particularly in the right hemisphere. |
| what characterizes hyperactivity in a child vs adult ADHD pt? | *child: can't sit through a whole class, impulsive situations/behavior, and talkative. *adult: repetitive finger/toe tapping, legs cross/uncross, difficulty staying in a meeting, risk-taking activity and talkative. |
| How can you reduce increase agitation, headaches and minimize growth issues? | Anxiety: decrease dose, HA: often resolve with a coupld of weeks, may need to reduce dose or try another stimulant, Growth: monitor growth charts, assess for genetic syndrome, dose dependent, resolve after d/c of stimulant RX |
| What does an evaluation for ADHD include? | A clinical interview, parent and teacher ratings, and sometimes, learning disorder or psychological testing. |
| what is on the conners teaching rating scale (for ADHD)? | this evaluates a child’s observed behavior, taking note of: hyperactivity, making noises, sensitivity, inattentiveness, relationships w/peers, destructive tendencies, problems in peer groups, problems w/authority. scored 0-3. >1.8 avg is more positive for ADHD. there is a parent's version as well noting: activity during meals, TV, and sleep (need to maintain routine). |
| What are the major differences between clonidine and guanfacine? | Guanfacine has more a 2A selectivity, a longer half-life, less sedation, hypotension, bradycardia than clonidine |
| What are characteristics of Pemoline? | Not a 1st line RX, risk of liver failure, alternative Rx only after a child has failed 3 or more stimulants |
| What are some characteristics of Ritalin LA | Capsule form with 50% imm release and 50% providing a second, delayed release, symptoms improve during the day but not in to the pm, replaces BID dosing with methylphindate. |
| How many people are affected by ADHD? | 2 million US children, 35% of children. 30-70% will continue to experience ADHD as adults. |
| what characterizes the incidence of ADHD? | it has been in in the literature since 1900. more prevalent in boys. more prevalent in families. |
| What do you do when ADHD is suspected | Thorough H&P: birth hx, risk factors, complications, vision, hearing, height, weight, diet, learning disabilities, genetics, family history |
| How can a child "grow out" of ADHD? | Recent studies show a delay in cortical development in some children with ADHD. |
| Describe the dosing schedule for alpha 2 agonists. |
Start clonidine 0.05 mg qhs X 3 days, then 0.05 mg TID Titrate clonidine 0.05 mg weekly; maximum = 0.4 mg/day Start guanfacine 0.5 mg qhs X 3 days, then 0.5 mg q 12 hr Titrate guanfacine 0.5 mg weekly; maximum = 4 mg/day Start guanfacine XR 1 mg q am, titrate weekly in 1 mg steps |
| What are some things you should know about Stattera | Few vital sign issue, no safety data on its use with low dose stimulants, do not use with TCA or Wellbutrin |
