Attention Deficit HyperactivityDisorder (ADHD)

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Part of chapter 16: Drugs for emotional, mood, and behavioral disorders.
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Attention Deficit HyperactivityDisorder (ADHD)
  1. Characteristics
    1. Not an emotional or mood disorder.
      1. Behavior disorder affecting as many as 5% of all children.
      2. Developmentally inappropriate behaviors involving difficulty paying attention or focusing on tasks.
        1. Diagnosed when hyperactivity interferes w/normal play, social, or learning.
          1. Child may be fidgety, impulsive, interrupt more, and talk excessively during developmental years. Social growth is delayed,
          2. Activity lvl more overt in boys; girls show less impulsiveness & aggression but more anxiety, mood swings, social withdrawal, and cognitive & language delays.
            1. Girls also tend to be older at time of diagnosis.
            2. Even gifted children may have trouble in school b/c they have difficulty following a conventional routine.
              1. Discipline may be a problem.
                1. Etiology largely unknown. Lead, prenatal exposure to drugs and alcohol, genetics, and environment may all be factors.
                  1. Sugars, chocolate, high-carb foods and beverages, and certain additives have been blamed, but that has been refuted.
                  2. Deficit or dysfunction of dopamine, norpeinephrine, or serotonin in the reticular activating system may be cause.
                    1. Families of these children must be educated about behavioral strategies for their children.
                      1. From an early age, the child must be educated about the disorder and understand there's consequences for actions.
                        1. Self-esteem should also be fostered so self-worth can develop.
                          1. Know importance of meds management & compliance.
                        2. 1/3-1/2 of ADHD children have it as adults.
                          1. Looks similar to a mood disorder
                            1. May have problems with keeping jobs, drug & alcohol abuse
                          2. Left untreated, it can cause low self-esteem, diminished social success, and criminal or violent behavior.
                          3. Pharmacotherapy
                            1. Main treatment is CNS stimulants.
                              1. These reverse many of the symptoms, helping pt. focus.
                                1. May cause paradoxical hyperactivity.
                                  1. Side effects include insomnia, nervousness, anorexia, weight loss, dizziness, depression, irritability, nausea, or abdominal pain.
                                    1. All are schedule II
                                      1. Methylphenidate (Ritalin) abuse is increasing in teens who want to stay awake or lose weight.
                              2. Non-CNS stimulants.
                                1. Less efficacy when taken alone, but good for adjunctive therapy.
                                  1. Atomoxetine (Strattera) selectively inhibits presynaptic release of norepinephrine
                                    1. Some of these drugs work for 24 hr w/few and tolerable adverse effects.
                                      1. Similar efficacy to methylphenidate,
                                        1. Side effects include headache, insomnia, upper abdominal pain, anorexia, and cough.
                                          1. Not a scheduled substance.
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