ADHD_Coll - ADHD Evaluation & Treatment...

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ADHD Edward J. Coll, M.D. COL, MC Chief, Developmental Pediatrics Walter Reed Army Medical Center
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Practice Guidelines Primary care clinicians Children 6-12 years old Framework for diagnostic decisionmaking Evidence based review
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Review and Recommendations Strong recommendation : high-quality scientific evidence or strong expert consensus Fair/weak : lesser quality, limited data, or expert consensus Clinical Options : reasonable provider
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Recommendation #1 If inattention, hyperactivity, impulsivity, academic underachievement, behavior problems Primary care clinician needs to initiate the evaluation Good evidence Strong recommendation
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Screening Questions How is __ doing in school? Are there any problems with learning that you/teacher see? Is your child happy in school? Are you concerned…behaviors at home/school/play with friends? Is your child having problems completing classwork or homework
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Recommendation #2 ADHD diagnosis must meet DSM-IV criteria Symptoms and functional impairment Criteria remain subjective and no reliable measures in primary care Good evidence Strong recommendation
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DSM-IV Criteria 6 of 9 symptoms often Inattentive Hyperactive/Impulsive Combined (both) causes distress or impairment inconsistent with developmental level
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DSM-IV Criteria starts before 7 years old lasts over 6 months two or more situations not due to: Autism, Pervasive Dev Disorder Mood or Anxiety Disorder Psychotic Disorder Dissociative or Personality Disorder
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DSM-IV Criteria Inattention fails to give close attention to details, makes careless mistakes in schoolwork or other activities has difficulty sustaining attention to task or play activities does not seem to listen what is said to him/her
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DSM-IV Criteria Inattention not follows through on instructions; fail to finish schoolwork, chores, duties in workplace (not due to oppositional behavior or failure to understand) difficulty organizing tasks/activities avoids/dislikes tasks that require sustained mental effort
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DSM-IV Criteria Inattention loses things necessary for tasks or activities (school assignments, pencils, books, tools, toys) easily distracted by extraneous stimuli forgetful in daily activities
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DSM-IV Criteria Hyperactivity /Impulsivity often fidgets with hands/feet or squirms in seat leaves seat in classroom or in other situations in which remaining seated is expected runs about or climbs excessively where inappropriate (teens or adults may be limited to subjective feelings of restlessness
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DSM-IV Criteria Hyperactivity /Impulsivity difficulty playing or engaging in leisure activities quietly talks excessively acts as if “driven by a motor” and cannot remain still
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DSM-IV Criteria Hyperactivity / Impulsivity blurts out answers before questions completed difficulty waiting in lines or for turn in games or group situations interrupts or intrudes on others
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Dr. Barkley’s ADHD Graph * Level of Interest Work X “Normal” ADHD
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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ADHD_Coll - ADHD Evaluation & Treatment...

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