Attention Deficit HyperactivityDisorder (ADHD)

Attention Deficit HyperactivityDisorder (ADHD)

1. Characteristics

   • Not an emotional or mood disorder.
     • Behavior disorder affecting as many as 5% of all children.
   • Developmentally inappropriate behaviors involving difficulty paying attention or focusing on tasks.
   • Diagnosed when hyperactivity interferes w/normal play, social, or learning.
     • Child may be fidgety, impulsive, interrupt more, and talk excessively during developmental years. Social growth is delayed,
   • Activity lvl more overt in boys; girls show less impulsiveness & aggression but more anxiety, mood swings, social withdrawal, and cognitive & language delays.
     • Girls also tend to be older at time of diagnosis.
   • Even gifted children may have trouble in school b/c they have difficulty following a conventional routine.
   • Discipline may be a problem.
   • Etiology largely unknown. Lead, prenatal exposure to drugs and alcohol, genetics, and environment may all be factors.
     • Sugars, chocolate, high-carb foods and beverages, and certain additives have been blamed, but that has been refuted.
   • Deficit or dysfunction of dopamine, norpeinephrine, or serotonin in the reticular activating system may be cause.
   • Families of these children must be educated about behavioral strategies for their children.
     • From an early age, the child must be educated about the disorder and understand there's consequences for actions.
       • Self-esteem should also be fostered so self-worth can develop.
       • Know importance of meds management & compliance.
   • 1/3-1/2 of ADHD children have it as adults.
     • Looks similar to a mood disorder
       • May have problems with keeping jobs, drug & alcohol abuse
   • Left untreated, it can cause low self-esteem, diminished social success, and criminal or violent behavior.

2. Pharmacotherapy

   • Main treatment is CNS stimulants.
     • These reverse many of the symptoms, helping pt. focus.
       • May cause paradoxical hyperactivity.
         • Side effects include insomnia, nervousness, anorexia, weight loss, dizziness, depression, irritability, nausea, or abdominal pain.
           • All are schedule II
             • Methylphenidate (Ritalin) abuse is increasing in teens who want to stay awake or lose weight.
   • Non-CNS stimulants.
     • Less efficacy when taken alone, but good for adjunctive therapy.
       • Atomoxetine (Strattera) selectively inhibits presynaptic release of norepinephrine
         • Some of these drugs work for 24 hr w/few and tolerable adverse effects.
         • Similar efficacy to methylphenidate,
         • Side effects include headache, insomnia, upper abdominal pain, anorexia, and cough.
         • Not a scheduled substance.