ADHD

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Basics

  • aka ADHD or ADD
  • the most common behavioural disorder prepubertal children 3-5 %
  • leads to significant morbidity
    • 30 % never finish high school
    • 40 % of males will be arrested for a felony by age 16 (US data)
    • 52 % will have drug or alcohol problems

Diagnosis

  1. Either (1) or (2) for at least 6 months to a degree that is maladaptive and inconsistent with developmental level
    1. 6 or more of the following symptoms of inattention
    2. 6 or more of the following symptoms of hyperactivity or impulsivity
  2. impairment caused by symptoms before age 7 years
  3. Some impairment from symptoms present in 2 or more settings
  4. Clear evidence of clinically significant impairment in social, academic, or occupational functioning
  5. Symptoms do not appear exclusively during the course of a PDD or other Psychotic Disorder, and are not better accounted for by another mental disorder (e.g. mood disorder)

Pathophysiology

  • decreased blood flow & metabolic rate in frontal lobes
  • decreased extracellular dopamine & increased dopamine transporters
  • increased peripheral norepinephrine may feedback to reduce central noradrenergic system

Treatment

The key is Skills plus Pills

Biological treatment specific to ADHD

  • Stimulant medication
  • Antidepressants
  • Clonidine
  • Anticonvulsant or Neuroleptics

Biological treatment not specific to ADHD

  • address any comorbid condition

Psychological Intervention (Environmental)

  • Parent coaching
  • Structured day
  • Adequate exercise
  • Consistent day/night cycle - understand energy cycle
  • Clear rules & consistent limit setting
  • Appropriate academic or work placement
  • Specific accommodations
  • Address learning disabilities

Psychological Intervention (Personal)

  • Opportunity to discuss condition & medication(s)
  • Social Skills training
  • Anger management training
  • Organizational skill training
  • Adult-led structured recreational activities
  • Mastery of age appropriate skills - goal setting

Social, educational and familial issues in treatment

Complications

Resources