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31 Cards in this Set
- Front
- Back
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What is the prevalence of ADHD?
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5%
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Causes?
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Hundreds proposed, from chemical to environmental to psychological.
80% hereditary. |
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DSM IV Criteria for ADHD
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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 |
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What is a layman's term for impulsivity?
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Annoying. Not waiting one's turn, blurting out, etc.
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ADHD is a Dx of...
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Exclusion!
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What are the two main subtypes of ADHD?
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Primarily Inattentive
Combined Type (Primarily Hyperactive Subtype? Rarely hyperactive w/o inattention.) |
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What type are "mind wanderers'? What about those whose "feet follow."
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Primarily inattentive
Combined type |
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What needs to be done to make Dx?
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Hx
Observation Dialogue w/ teacher Response to treatment |
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Which group are often erroneously diagnosed w/ ADHD?
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"Bad boys"
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Which group are often missed?
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"good girls"
- kids pacified by games systems |
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Drawbacks to Tx
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High NNT
Side effects / stigma Long term improvement? |
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Quack Cures
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None of them work!
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Tartazine?
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A diet stuffed with tartazine may cause ADHD but tartazine free diet does nothing.
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Sugar? Omega threes?
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No difference.
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Will foods make kids hyper?
Avoid any foods? |
No.
Yes. Avoid too many sweets, pop, food coloring. |
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Behavioural Therapy?
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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) |
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Pharmacotherapy?
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DOES have an effect.
Methylphenidate leads to better outcomes. |
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Side Fx of Ritalin
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- 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 |
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Serious Side Fx
- Tourrette's -Poor growth - Arrhythmias |
No, no, no. Clinically irrelevant increase in BP by 4mmHg and HR by 6bpm
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What is Primary Nocturnal Enuresis?
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Congenital and continual beyond 6 years. No streak of PERFECTLY dry nights for > 6months.
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What is Secondary Enuresis?
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- Acquired after a streak of > 6 months. Can be diurnal (i.e. awake) or nocturnal (while asleep.)
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Red Flags with Enuresis
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- Diurnal enuresis in school age kids
- ANY secondary enuresis |
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Enuresis: Worrying Causes
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- Primary: CNS: seizures, UMN
- Secondary: UTI, diabetes, bullies, constipation, injury - play station! |
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What causes Primary Enuresis?
a) physiologic b) psychological c) deep sleep |
C Deep Sleep
Children with primary enuresis spend more time in REM sleep |
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Tx
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Benign neglect in most cases.
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Is there evidence for behavioural management?
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No. Not even positive reinforcement.
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Imipramine (TCA)?
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Not recommended unless in exceptional circumstances.
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Desmopressin?
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Yes, use only to prevent embarrassing accidents, i.e. at camp. Take one hour before bed.
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Sleep alarms?
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They do work but only for highly motivated teens. Wake up whole house.
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When to Treat
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- Cobedding
- Sleep overs etc - Failure of nonmedical management / can't convince family to wait longer |
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What is the most successful (if not the first line / most recommended) therapy?
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Sleep alarm. But only effective in 50% of kids.
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