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Name the 3 socially disruptive behavioral disorders in children

ADHD, oppositional defiant disorder, conduct disorder

Examples of behaviors seen in conduct disorder

• Aggression to people and/or animals
• Destruction of property
• Deceitfulness or theft
• Serious violations of rules

Examples of behaviors seen in oppositional defiant disorder

• often loses temper
• often argues with adults
• often actively defies or refuses to comply with adults' requests or rules
• often deliberately annoys people
• often blames others for his or her mistakes or misbehavior
• is often touchy or easily annoyed by others
• is often angry and resentful
• is often spiteful or vindictive

Name the 3 categories of ADHD behavior

impulsivity, inattention, hyperactivity

Why is it possible that a child may not exhibit sx of ADHD in your office?

Sx may be decreased in settings of:
o frequent reinforcement
o very strict control
o novel settings
o one-on-one interaction

Why treat ADHD?

It is associated with learning disabilities, academic underachievement, low self-esteem and temper outbursts
Stimulant treatment of ADHD found to reduce the risk of later substance abuse by as much as 75%

Name some comorbidities with ADHD

o One third with Oppositional Defiant Disorder
o One quarter with Conduct Disorder
o Less than 20% with Depression
o More than 25% with Anxiety
o One third with more than one comorbid condition

What is a normal attention span for a child?

o 3-5 minutes per year of age

What 2 adults must give you input before a diagnosis of ADHD can be made?

the caregiver and the child's teacher (usually) b/c some impairment must be present in at least 2 settings

mainstay of ADHD management

psychostimulant medications

MOA psychostimulant meds

Not well understood, but enhances activity of catecholamines.

Why do most kids with ADHD need 2 doses of methylphenidate per day (at least)?

b/c the T1/2 is only 1-2 hours with peak clinical effect w/in 4 hours

Common SE methylphenidate

• anorexia
• insomnia
• stomach ache
• headache
These are DOSE-DEPENDENT and tend to decrease with time.

Rare but serious SE methylphenidate

Tics, growth retardation (improves when med withheld)

Does every kid with ADHD need an EKG before starting a drug?

no, but they should get a targeted CV history & FH with PE to look for CV disease risk factors

Name some drugs that can be used to treat ADHD

-psychostimulants (methylphenidate, dextramphetamine, adderall)
-atomoxetine (NE reuptake inhibitor)
-TCA (3rd line)
-clonidine or guanfacine

At what point in tx do you typically switch to a long-acting formulation?

when the child doesn't want to take the med from the nurse anymore; older children can go to long acting or transdermal patch

Before jumping to an evaluation of ADHD, what should you evaluate in a child who is struggling in school?

vision & hearing

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