ADHD

=Attention Deficit Hyperactivity Disorder=

What it is
[|DSM-IV criteria for diagnosis of ADHD] At least 6 symptoms of inattention and/or 6 symptoms of hyperactivity/impulsivity having persisted for at least 6 months. - Some of these symptoms present before 7 years of age - Impairment occuring in at least two different settings (school and home). - Clear evidence of clinically significant impairment in social, academic, or occupational functioning. - Not better accounted for by another mental disorder or symptoms occuring during a course of a mental disorder.

- Parental ADHD - Low birth weight - Cigarette and alcohol exposure in utero - Genetics (7-repeat allele of the D4 dopamine receptor gene. 50-60% vs 30% in controls)
 * Risk factors:**

Symptoms
//only a few are listed here, view full list [|here]// - Failure to give close attention to details or may make careless mistakes - Difficulty sustaining attention in tasks or play activities, may not seem to listen when spoken to directly. - May not follow through on instructions and may fail to finish schoolwork and chores,
 *  Inattention**

- Frequent fidgetiness with hands or feet or squirming particularly when required to sit still - Difficulties playing or engaging in leisure activities quietly, or may talk excessively. As the child grows into adolescence or adulthood, this may subside and feelings of restlessness may remain.
 * Hyperactivity**

- Child often blurts out answers before questions have been completed - Has difficulties awaiting his/her turn
 * Impulsivity **

//Symptoms often result in:// - Impairment in academic achievement and school failure - Impairment in psychosocial functioning (peer relationships) - Family conflict

How to Treat
- reuptake inhibitors of dopamine and NA - short duration of action. Can use long-acting methylphenidate (8-12hr modified release) - if one does not work, then can switch to other //Dexamphetamine// Initially, 2.5mg once-twice daily. Can be raised in 2.5-5mg increments at weekly intervals until optimal response is obtained. Maximum of 0.5.mg/kg/day or 40mg in 2 divided doses.
 * Psychostimulants**
 * -** tolerance does not develop long-term

//Methylphenidate// Initially, 5mg once-twice daily. Can be raised in 5-10mg increments at weekly intervals. Maximum of 1mg/kg/day or 60mg in 2-3 divided doses.

Initially, 0.5mg/kg (max 40mg). Increase after minimum 7 days to target total dose of 1.2mg/kg (max 80mg) daily (once or split). Max of 1.4mg/kg (max 100mg) after 2-4 weeks. - response more delayed than psychostimulants - efficacy seems to be less than psychostimulants - increases blood pressure and heart rate
 * Atomoxetine** //SNRI//

Initially, 1 microgm/kg daily (max 50microgm). Increase by 25-50microgm every 3rd day up to 3-4microgm/kg daily (max 150/dose, 300/day). Give in 2-3 divided doses. - better for hyperactivity and impulsivity, not attention - give smaller doses at night - care with stimulants or other cardiotoxic medications (TCAs)
 * Clonidine** //partial alpha-2 agonist//

Other advice
- treatment is generally long-term - educate family members, teachers - annual discontinuation trials to see if medication still beneficial - behaviour modification methods in the classroom

Additional Resources
[|DSM-IV criteria for diagnosis of ADHD] [|ADHD.com.au - Assessment]: contains criteria on what inattention, hyperactivity and impulsivity are