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this blog is no substitute for treatment

Every recommendation is not right for everyone. And, blogs don't have editors & inevitably I will have inaccuracies despite my efforts. So do not change your treatment or medications in any way without first consulting your own therapist and physician!

Friday, September 16, 2011

notes: ADHD basics

For those of you versed in attention deficit hyperactivity disorder (ADHD), skip this post as it is quite basic. The following are a few notes from another NEI talk -- this time from Jensen.
  • Diagnosis
  • ADHD in 5-8% children
  • About the same number of girls and boys have inattentive type ADHD.
  • Boys predominate with combined or hyperactive types.
  • Remember ADHD can be especially hard to pick up in kids who have super compensating strategies. For these kids ADHD may only become apparent as they get older and demands increase on them.
  • Comorbidity
  • About 2/3 of kids with ADHD have a comorbid disorder!
  • ie the average kid with ADHD carries 2 diagnoses!!
  • Most common comorbid disorders include most commonly oppositional defiant disorder, but also conduct disorder, anxiety disorders, depression, learning disorders and tics.
  • Treatment
  • Atomoxetine takes longer to work and is less dependable than stimulants.
  • Atomoxetine has some reports of liver toxicities.
  • Stimulants have a big impact. Doesn't matter if you start with a methylphenidate or amphetamine compound.
  • Long lasting forms of stimulants make treatment easier.
  • "Nuisance" side effects from stimulants include headaches, decreased appetite and insomnia. Sharing side effect management strategies ahead of time can help.
  • Another possible side effect is loss in height of a couple of centimeters. May be due to changing dopamine impacts on hypothalamus which then impacts growth hormone. Or, perhaps the loss in height is due to the decrease in appetite.
  • Electrocardiograms (EKGs) are primarily needed in kids with cardiac histories or relevant cardiac family histories.
  • Psychoeducation of parents is a critical component of treatment. Parents benefit from understanding that the ADHD child is not a "bad" child or just "willful."
  • Parents need to get a "black belt in parenting strategies" for the ADHD child including behavioral strategies.
  • ADHD over time
  • For the young school child hyperactivity is a prominent symptom.
  • By middle school the child travels to multiple classes so hyperactivity can be less prominent. However, organizational symptoms may appear more prominent and problematic as cognitive and organizational demands skyrocket.
  • Also, as kids become older the impulsivity of ADHD can become more dangerous. It can lead to dangerous driving, unprotected sex and substance abuse.
  • Over 50% of adolescents stop medications during teen years!
  • During teen years the parents and child need to find a way for the child to take increasing responsibility for managing the ADHD. Kids benefit from participating actively in the treatment or symptom management process.
  • All medications that work in children also appear to work in adults.
  • Medicating adults can be trickier as adults have had "more hits" in life. ADHD has had an opportunity to impact them for longer. So ADHD can be ever more complicated by other symptoms like anxiety, depression, or substance abuse.
  • Keep in mind that medication diversion is rampant.
  • Genes for ADHD are likely to have some adaptive use. Focusing on the positive aspects of ADHD as well as managing the negative, can be of help.

at 8:16 PM

2 comments:

  1. Dr Bremer,

    Thank you for posting these synopses or "snapshots" from the NEI materials. I agree they are valuable and interesting.

    One suggestion: it might be informative to include, if possible, the source of funding for each of these exercises. I don't know if NEI discloses which pharmaceutical companies have underwritten their online lessons, but if so, this would be useful information.

    ReplyDelete

  2. Thanks for the comment. Good point.

    Your comment motivates me to at least make a blanket comment: I routinely maximize therapy and holistic approaches first line. Especially exercise, diet, behavioral measures and therapy are critical for most clients, and for many that is all that is needed. I do this as most medications have serious shortcomings and risks. And, many bigwigs in psychopharmacology have affiliations with or funding from drug companies, which inevitably at times influences information shared. That being said, many medications can be a godsend for many who come in my office. Therefore, I am grateful for the researchers, academic centers and for the pharmaceutical companies who move research forward. I am also grateful for those who remind us to carefully keep an eye on where information comes from. Or who funds it.

    Dr. Steve, I hope the blanket comment helps? Thanks again for the post.

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