AD/HDAD/HDGeneral Medical InformationGeneral Medical Information
Mary Margaret Dagen, M.D.Mary Margaret Dagen, M.D. Westshore Family MedicineWestshore Family Medicine
April 24, 2013April 24, 2013
AD/HD- DefinitionAD/HD- Definition
6 or more symptoms of inattention for at least 6 or more symptoms of inattention for at least 6mos to a degree that is inconsistent 6mos to a degree that is inconsistent w/developmental levelw/developmental level
6 or more symptoms of hyperactivity-impulsivity 6 or more symptoms of hyperactivity-impulsivity for at least 6mos that is inconsistent for at least 6mos that is inconsistent w/developmental levelw/developmental level
Symptoms present before age 7Symptoms present before age 7 Impairment from symptoms present in 2 or Impairment from symptoms present in 2 or
more settingsmore settings Clinically significant impairment in social, Clinically significant impairment in social,
academic, or occupational functioningacademic, or occupational functioning Symptoms do not occur exclusively in another Symptoms do not occur exclusively in another
mental disordermental disorder
AD/HD- DefinitionAD/HD- Definition
InattentionInattention
Fails to give close attention to details or makes Fails to give close attention to details or makes careless mistakescareless mistakes
Difficulty sustaining tasks/activitiesDifficulty sustaining tasks/activities Does not listen when spoken to directlyDoes not listen when spoken to directly Does not follow through on instructions or complete Does not follow through on instructions or complete
taskstasks Difficulty organizing tasks/activitiesDifficulty organizing tasks/activities Avoids, dislikes, reluctant to engage in tasks that Avoids, dislikes, reluctant to engage in tasks that
require sustained mental effortrequire sustained mental effort Easily distracted by extraneous stimuliEasily distracted by extraneous stimuli Forgetful in daily activitiesForgetful in daily activities
AD/HD- DefinitionAD/HD- Definition
HyperactivityHyperactivity
Fidgets with hands/feet or squirms in seatFidgets with hands/feet or squirms in seat Leaves seat in classroom or other situations in which Leaves seat in classroom or other situations in which
remaining seated is expectedremaining seated is expected Runs about or climbs excessively in situations in which Runs about or climbs excessively in situations in which
it’s inappropriateit’s inappropriate Difficulty playing or engaging in leisure activities Difficulty playing or engaging in leisure activities
quietlyquietly Talks excessivelyTalks excessively Often ‘on the go’ or acts as if ‘driven by a motor’Often ‘on the go’ or acts as if ‘driven by a motor’
AD/HD- DefinitionAD/HD- Definition
ImpulsivityImpulsivity
Difficulty awaiting turn in games or Difficulty awaiting turn in games or group situationsgroup situations
Blurts out answers to questions before Blurts out answers to questions before they have been completedthey have been completed
Interrupts or intrudes on othersInterrupts or intrudes on others
AD/HD- EpidemiologyAD/HD- Epidemiology
16% increase in diagnosis since 200716% increase in diagnosis since 2007 3.7% children in U.S. have been 3.7% children in U.S. have been
diagnoseddiagnosed Boys are more likely to be diagnosed Boys are more likely to be diagnosed
(13.2% boys vs 5.6% girls)(13.2% boys vs 5.6% girls) Rates are increasing in teens Rates are increasing in teens
compared to young childrencompared to young children
AD/HD- DiagnosisAD/HD- Diagnosis
Learning disordersLearning disorders 50% those 50% those diagnosed with ADHD have co-morbid diagnosed with ADHD have co-morbid learning disabilitieslearning disabilities
Oppositional defiant disorderOppositional defiant disorder starts starts before age 8. lose temper, argue, refuse before age 8. lose temper, argue, refuse to follow rules, deliberately annoyto follow rules, deliberately annoy
Conduct disorderConduct disorder aggression towards aggression towards others, violations of rules/lawsothers, violations of rules/laws
Mental disordersMental disorders anxiety, depression anxiety, depression
AD/HD- DiagnosisAD/HD- Diagnosis
Medical examMedical exam Evaluate hearing & visionEvaluate hearing & vision
Ratings scales & checklistsRatings scales & checklists Conner’s Parent & Teacher rating scaleConner’s Parent & Teacher rating scale
AD/HD- DiagnosisAD/HD- Diagnosis
Conner’s rating scaleConner’s rating scale
AD/HD- TreatmentAD/HD- Treatment
StimulantsStimulants (Ritalin, Adderall, Concerta, (Ritalin, Adderall, Concerta, Daytrana, Focalin, Vyvanse, etc)Daytrana, Focalin, Vyvanse, etc)
Stimulates CNS (brain) activity by blocking Stimulates CNS (brain) activity by blocking reuptake & increases release of reuptake & increases release of norepinephrine & dopaminenorepinephrine & dopamine
Side effectsSide effects decreased appetite, insomnia, decreased appetite, insomnia, anxietyanxiety
70-80% children respond positively to these70-80% children respond positively to these
AD/HD- TreatmentAD/HD- Treatment
Non-stimulantsNon-stimulants (Strattera, Intuniv, (Strattera, Intuniv, Tenex, Kapvay, Wellbutrin, etc)Tenex, Kapvay, Wellbutrin, etc) Most still affect norepinephrine system, Most still affect norepinephrine system,
but at a different level so they are not but at a different level so they are not directly stimulatingdirectly stimulating
Less side effect profileLess side effect profile
AD/HD- Treatment AD/HD- Treatment GuidelinesGuidelines
Preschool (4-5yo): behavioral Preschool (4-5yo): behavioral therapy is 1therapy is 1stst line. If this doesn’t line. If this doesn’t provide significant improvement, provide significant improvement, trial of stimulanttrial of stimulant
Elementary (6-11yo): stimulants are Elementary (6-11yo): stimulants are 11stst line, + behavioral therapy line, + behavioral therapy
Adolescents (12-18yo): medications Adolescents (12-18yo): medications + behavioral therapy + behavioral therapy
AD/HD- Behavioral TherapyAD/HD- Behavioral Therapy
Create routineCreate routine OrganizationOrganization Avoid distractionsAvoid distractions Limit choicesLimit choices Change interactions to brief explanationsChange interactions to brief explanations Use goals w/rewardsUse goals w/rewards DisciplineDiscipline Help child discover a talentHelp child discover a talent
AD/HD- Alternative AD/HD- Alternative TherapiesTherapies
Screen time & dietScreen time & diet no direct relation no direct relation Feingold diet- sensitivity to dietary salicylates & Feingold diet- sensitivity to dietary salicylates &
artificially added colors/flavors/preservativesartificially added colors/flavors/preservatives no relationno relation
SupplementsSupplements essential fatty acids, essential fatty acids, glyconutritional supplements, vitamins, amino glyconutritional supplements, vitamins, amino acids, Ginko biloba, herbalsacids, Ginko biloba, herbals
Sensory integrationSensory integration not specific to AD/HD not specific to AD/HD Interactive Metronome trainingInteractive Metronome training promising promising Cerebellar training, anti-motion sickness, yeast Cerebellar training, anti-motion sickness, yeast
infections, neurofeedback, chiropractic, thyroid, infections, neurofeedback, chiropractic, thyroid, leadlead no direct relation to improvement no direct relation to improvement
AD/HDAD/HD
www.cdc.gov www.help4adhd.org American Psychiatric AssociationAmerican Psychiatric Association American Academy of Family American Academy of Family
PhysiciansPhysicians American Academy of PediatricsAmerican Academy of Pediatrics
AD/HDAD/HD
QUESTIONS??QUESTIONS??