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Clinician’s Corner: Treatment of Attention Deficit/Hyperactivity Disorder

BACKGROUND:

What’s in a name??

Up until 1987 this condition was called attention deficit disorder (ADD), but this is an outdated term. The term was once used to refer to someone who had trouble focusing but was not hyperactive. Since 1987 ADHD is the term used by the American Psychiatric Association.

Who’s got it?

ADHD affects between 5% of all children (American Psychiatric Association) and 11% (CDC’s number) possibly as many as 6.4 million American children. Boys are more likely to be diagnosed with ADHD than girls (12.9% compared to 5.6%)

DIAGNOSIS

There are three types of ADHD:

  • inattentive (trouble focusing, following instructions, and finishing tasks)
  • hyperactive-impulsive (constantly on the go, talking excessively, and interrupting others)
  • combined (symptoms of both inattention and hyperactivity-impulsivity)

To meet the diagnostic criteria according to the DSM-5 (Diagnostic and statistical Manual of psychiatric disorders) a few aspects must be considered to meet a diagnosis of ADHD:

Inattention: Six or more symptoms of inattention for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:

  1. Has lack of detail or makes careless mistakes.
  2. Has difficulty paying attention.
  3. Doesn’t pay attention when spoken to directly.
  4. Doesn’t follow instructions or fails to complete homework or other tasks.
  5. Often seems disorganized.
  6. Avoids tasks requiring sustained mental effort or concentration.
  7. Often loses things needed for tasks (toys, pencils, homework).
  8. Becomes easily distracted.
  9. Is forgetful

Hyperactivity/Impulsivity Six or more symptoms of hyperactivity-impulsivity for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:

  1. Often fidgets, taps hands, squirms in seat.
  2. Gets up and moves around during activities in situations when remaining seated is expected.
  3. Often runs or climbs in inappropriate situations.
  4. Is unable to play quietly.
  5. Seems “driven by a motor.”
  6. Talks excessively.
  7. Blurts out answers before complete question is given.
  8. Can’t seem to wait for his or her turn.
  9. Interrupts or intrudes others often.

In addition, the following conditions must be met:

  • Several symptoms were present before age 12 years.
  • Several symptoms are present in two or more setting (such as home/school/work.)

Symptoms interfere with, or reduce the quality of, social, school, or work functioning. Ruled out other mental health disorders, situational or physical conditions.

More severe cases of ADHD in children, as described by parents, were diagnosed earlier.

  • The median age of diagnosis for severe ADHD was 4 years.
  • The median age of diagnosis for moderate ADHD was 6 years.
  • The median age of diagnosis for mild ADHD was 7 years

Your Thompson Pharmacist wants to help you and your children succeed.  Next week we will discuss the use of stimulants commonly used for attention deficit hyperactivity disorder.  Go ahead and ASK…. At Thompson Pharmacy it’s ALL for YOU!