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