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31 Cards in this Set

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What is the prevalence of ADHD?
5%
Causes?
Hundreds proposed, from chemical to environmental to psychological.

80% hereditary.
DSM IV Criteria for ADHD
A) Inattention (with six of many cardinal symptoms)

AND / OR

B) Hyperactivity / Impulsivity

Plus...
evidence of impairment before age 7, evidence of functional impairment, no other Dx
What is a layman's term for impulsivity?
Annoying. Not waiting one's turn, blurting out, etc.
ADHD is a Dx of...
Exclusion!
What are the two main subtypes of ADHD?
Primarily Inattentive
Combined Type
(Primarily Hyperactive Subtype? Rarely hyperactive w/o inattention.)
What type are "mind wanderers'? What about those whose "feet follow."
Primarily inattentive
Combined type
What needs to be done to make Dx?
Hx
Observation
Dialogue w/ teacher
Response to treatment
Which group are often erroneously diagnosed w/ ADHD?
"Bad boys"
Which group are often missed?
"good girls"
- kids pacified by games systems
Drawbacks to Tx
High NNT
Side effects / stigma
Long term improvement?
Quack Cures
None of them work!
Tartazine?
A diet stuffed with tartazine may cause ADHD but tartazine free diet does nothing.
Sugar? Omega threes?
No difference.
Will foods make kids hyper?
Avoid any foods?
No.
Yes. Avoid too many sweets, pop, food coloring.
Behavioural Therapy?
effective for ADHD + associated behavioural problems.
Not more effective than meds for pure ADHD (and probably bad for child as he is put in special class)
Pharmacotherapy?
DOES have an effect.
Methylphenidate leads to better outcomes.
Side Fx of Ritalin
- Appetite suppression is invariable but clinically significant. Kids won't eat much lunch but will eat later.
- Temporary insomnia
- Emotional after school
- Anxiety if predisposed
- Rare to get serious side fx
Serious Side Fx
- Tourrette's
-Poor growth
- Arrhythmias
No, no, no. Clinically irrelevant increase in BP by 4mmHg and HR by 6bpm
What is Primary Nocturnal Enuresis?
Congenital and continual beyond 6 years. No streak of PERFECTLY dry nights for > 6months.
What is Secondary Enuresis?
- Acquired after a streak of > 6 months. Can be diurnal (i.e. awake) or nocturnal (while asleep.)
Red Flags with Enuresis
- Diurnal enuresis in school age kids
- ANY secondary enuresis
Enuresis: Worrying Causes
- Primary: CNS: seizures, UMN
- Secondary: UTI, diabetes, bullies, constipation, injury
- play station!
What causes Primary Enuresis?
a) physiologic
b) psychological
c) deep sleep
C Deep Sleep
Children with primary enuresis spend more time in REM sleep
Tx
Benign neglect in most cases.
Is there evidence for behavioural management?
No. Not even positive reinforcement.
Imipramine (TCA)?
Not recommended unless in exceptional circumstances.
Desmopressin?
Yes, use only to prevent embarrassing accidents, i.e. at camp. Take one hour before bed.
Sleep alarms?
They do work but only for highly motivated teens. Wake up whole house.
When to Treat
- Cobedding
- Sleep overs etc
- Failure of nonmedical management / can't convince family to wait longer
What is the most successful (if not the first line / most recommended) therapy?
Sleep alarm. But only effective in 50% of kids.