• 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
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