Case 1 - ADHD Flashcards
(15 cards)
ADHD triad
- Issues with attention
- Hyperactivity
- Impulsivity
Typical behaviours of child with ADHD
- Issues taking turn
- Interupt frequently
- Difficulty to pay attention
- Difficulty sitting still
Investigations for ?ADHD in clinically well child
- None needed
- Blood test can be considered if diagnosed and starting stimulant medications
Side effects of stimulant medications used to treat ADHD
- Leukopenia
- Pancytopenia
- Hepatic coma
Can be useful to do baseline FBC and LFT before commencing
Screening tools useful in assessment of ADHD
- Conners questionaire
- Dundee difficult times of the day scale D-DTODs
- SNAP - IV
- Strengths and difficulties questionaire
These can be used for initial, monitoring medication effectiveness and monitoring symptoms over time
DSM V criteria for ADHD - subtypes
- Inattention criteria
- Hyperactivity criteria
- Impulsivity criteria
Diagnosis made when at least 6 of criteria from wither inattention or hyperactivity/impulsivity are met and are present before age of 12 for 6 months and in more than 1 setting
Inattention criteria DSM 5
- easily distracted by extraneous stimuli”,
- “forgetful in daily activities” and
- “often has difficulty sustaining attention in tasks or play activities”.
Hyperactivity criteria
- often fidgets with hands or feet or squirms in seat”,
- “often talks excessively” and
- “is often on the go or often acts as if driven by a motor”.
Impulsivity criteria DSM V
- often has difficulty waiting turn” and
- “often bursts out answers before questions have been completed”.
Differentials for ADHD
- Auditory processing disorder - problems following instructions
- Oppositional defiant disorder or conduct disorder - aggression, anger, vindictiveness, argumentative
Management of ADHD
- Preschool children - medication not recommended. Parents offered training programme and teachers should be informed of educational needs
- Mild-moderate - behavioural strategies delivered in form of parent education sessions. Can also try CBT and social skills training for child
- Severe ADHD - medication eg Methyphenidate
Side effects of ADHD medications
- Raised BP
- Palpitations
- Disturbed sleep
- Impaired growth and appetite supression
- Aggression or anxious, emotional or depressed
What to do if child has FH of significant heart disease and wants to commence medication for ADHD?
- BP measurement
- ECG with QTc calculation
- 24hr ECG tape monitoring - maybe
- Echocardiogram
Refer for paediatric cardiologist assessment for this
Parameters to monitor when children are on ADHD medication
- Blood pressure
- Height
- Weight - due to appetite suppression, growth can stop
- Pulse
Rare side effects of ADHD medication
- Cardiac arrest
- Angina
- Neuroleptic malignant syndrome
- Sudden cardiac death
