1. AD/HD General Medical Information Mary Margaret Dagen, M.D. Mary Margaret Dagen, M.D. Westshore Family Medicine Westshore Family Medicine April 24, 2013 April 24, 2013

2. AD/HD- Definition  6 or more symptoms of inattention for at least 6mos to a degree that is inconsistent w/developmental level  6 or more symptoms of hyperactivity-impulsivity for at least 6mos that is inconsistent w/developmental level  Symptoms present before age 7  Impairment from symptoms present in 2 or more settings  Clinically significant impairment in social, academic, or occupational functioning  Symptoms do not occur exclusively in another mental disorder

3. AD/HD- Definition  Inattention  Fails to give close attention to details or makes careless mistakes  Difficulty sustaining tasks/activities  Does not listen when spoken to directly  Does not follow through on instructions or complete tasks  Difficulty organizing tasks/activities  Avoids, dislikes, reluctant to engage in tasks that require sustained mental effort  Easily distracted by extraneous stimuli  Forgetful in daily activities

4. AD/HD- Definition  Hyperactivity  Fidgets with hands/feet or squirms in seat  Leaves seat in classroom or other situations in which remaining seated is expected  Runs about or climbs excessively in situations in which it’s inappropriate  Difficulty playing or engaging in leisure activities quietly  Talks excessively  Often ‘on the go’ or acts as if ‘driven by a motor’

5. AD/HD- Definition  Impulsivity  Difficulty awaiting turn in games or group situations  Blurts out answers to questions before they have been completed  Interrupts or intrudes on others

6. AD/HD- Epidemiology  16% increase in diagnosis since 2007  3.7% children in U.S. have been diagnosed  Boys are more likely to be diagnosed (13.2% boys vs 5.6% girls)  Rates are increasing in teens compared to young children

7. AD/HD- Diagnosis  Learning disorders  50% those diagnosed with ADHD have co-morbid learning disabilities  Oppositional defiant disorder  starts before age 8. lose temper, argue, refuse to follow rules, deliberately annoy  Conduct disorder  aggression towards others, violations of rules/laws  Mental disorders  anxiety, depression

8. AD/HD- Diagnosis  Medical exam  Evaluate hearing & vision  Ratings scales & checklists  Conner’s Parent & Teacher rating scale

9. AD/HD- Diagnosis  Conner’s rating scale

10. AD/HD- Treatment  Stimulants (Ritalin, Adderall, Concerta, Daytrana, Focalin, Vyvanse, etc)  Stimulates CNS (brain) activity by blocking reuptake & increases release of norepinephrine & dopamine  Side effects  decreased appetite, insomnia, anxiety  70-80% children respond positively to these

11. AD/HD- Treatment  Non-stimulants (Strattera, Intuniv, Tenex, Kapvay, Wellbutrin, etc)  Most still affect norepinephrine system, but at a different level so they are not directly stimulating  Less side effect profile

12. AD/HD- Treatment Guidelines  Preschool (4-5yo): behavioral therapy is 1 st line. If this doesn’t provide significant improvement, trial of stimulant  Elementary (6-11yo): stimulants are 1 st line, + behavioral therapy  Adolescents (12-18yo): medications + behavioral therapy

13. AD/HD- Behavioral Therapy  Create routine  Organization  Avoid distractions  Limit choices  Change interactions to brief explanations  Use goals w/rewards  Discipline  Help child discover a talent

14. AD/HD- Alternative Therapies  Screen time & diet  no direct relation  Feingold diet- sensitivity to dietary salicylates & artificially added colors/flavors/preservatives  no relation  Supplements  essential fatty acids, glyconutritional supplements, vitamins, amino acids, Ginko biloba, herbals  Sensory integration  not specific to AD/HD  Interactive Metronome training  promising  Cerebellar training, anti-motion sickness, yeast infections, neurofeedback, chiropractic, thyroid, lead  no direct relation to improvement

15. AD/HD  www.cdc.gov www.cdc.gov  www.help4adhd.org www.help4adhd.org  American Psychiatric Association  American Academy of Family Physicians  American Academy of Pediatrics

16. AD/HD  QUESTIONS??