Behavioural disorders : ADHD Flashcards
(14 cards)
How to manage children over 5 with ADHD
1st line
2nd line
1st line: After 10 Weeks of watch and wait! ADHD focused group parent - training programme
2nd - specialist services can prescibe medication
- 1st line medication = 6 week trial methylphenidate (Ritalin)
- 2nd line medication = lisdexamphetamine *
’ lis and dex like feta’ *
3rd line management for ADHD if there are still concerns even after medication?
CBT is third line
if significant impairment in social skills, self control, expressing feelings etc
Anyone over 5 who has ADHD and is not being managed with focus groups? Which medications are available 1st and 2nd line
[Management]
- 1st line medication = 6 week trial methylphenidate (Ritalin)
- 2nd line medication = lisdexamphetamine
Methylphenidate side effects and what is important to monitor?
[Management]
- 1st line medication = 6 week trial methylphenidate (Ritalin)
Abdo pain, nausea, dyspepsia, stunted growth
–> Monitor height every 6 months
–> If under 10 yrs monitor weight every 3 months
–> If over 10 years monitor weight every 6 months + BP + HR*
*Ritalin is cardiotoxic so monitor HR and BP 6 monthsl
- 2nd line medication = lisdexamphetamine
ADHD progression stats at they get older?
manifestation of ADHD will change as child gets older (hyperactivity tends to become less of a problem and inattention becomes more pronounced). Some may grow out of it, x% get conduct disorder if untreated, z% have ADHD as an adult.
[Prognosis]
x = 90
z = 15
What are some risk factors for ADHD? (6)
[Aetiology]
Family history
Conduct disorder
Learning disability
Autism spectrum
Anxiety
- other conditions basically
Obstetric (premature, SGA, fetal alcohol syndrome)
How to manage children under 5 with ADHD
- who do not meet full criteria
- who do meet full criteria
[Management]
Watchful waiting for 10 weeks
Refer to secondary care and offer ADHD focused group parent - training programme :
- 10-16 meetings in groups of 10-12
What is the criteria and definition of ADHD?
Persistent pattern for over 6 months in 2 settings of inattention and/or hyperactivity-impulsivity
This must interfere with functioning or development and unexplained by other disorders
What are the clinical features associated with inattention
[Clinical features]
- Struggles holding attention
- Struggles organising tasks
- Does not listen when spoken to
- Does not follow through instructions
- Dislike tasks requiring longer mental effort
- Easily distracted
- Forgetful + often loses items
What are the clinical features associated with hyperactivity?
[Clinical features]
- Unable to play quietly
- Talks excessively
- Does not wait their turn easily
- Will spontaneously leave their seat
- Is often ‘on the go’
- Interruptive or intrusive
- Answer prematurely to questions
- Run and climb when not appropriate
What to do if ritalin is causing stunted growth?
[Management]
referral and a planned break to allow catch-up growth.
What is inattention in ADHD
Lack of persistent tast involvement and quicjly moving on from incomplete tasks
What is overactivity in ADHD
Overactivity - characterised by restlessness, talkativeness, noisiness and fidgeting
What is the MDT approach?
[ADHD management]
paediatrician, psychiatrist, ADHD nurses, mental health and learning disability trusts, CAMHS, parent groups, social care, school/college.
Have to work together
