WHY DO WE TREAT

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WHY DO WE TREATADHD

• by Dr Eleanor Adams
• Specialty doctor
• CAMHS
• Telford and Wrekin

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DEFINITION OF ADHD

• A persistent pattern of inattention and
• hyperactivity that is developmentally
• inappropriate

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Why do we care about this?

• Children who persistently behave in an
  inattentive, restless and impulsive way are at
  risk of later antisocial adjustment, educational
  failure and aspects of personality dysfunction.
• They also present a significant challenge to
  their caregivers.

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Symptom Triad

• Inattentiveness
• Disorganisation, lack of persistence,
• easily distracted
• Overactivity
• Excess of movements
• Impulsiveness
• Acting without reflecting

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ADHD Epidemiology

• Incidence USA estimated to be 3 - 5
• Incidence UK estimated to be 1 3
• Males affected more than females with a male
• preponderance of 31

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ADHD - Comorbidity

• Over 50 - 80 have a comorbid disorder
• specific learning disorder,conduct disorder,
  oppositional defiant disorder, substance misuse,
  depression and tic disorder being among the most
  common.

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ADHD in school age children

• 90 under-produce schoolwork
• 90 underachieve in school
• 20 have reading difficulties
• 60 have serious handwriting difficulties
• 30 drop out of school
• 5 complete a degree course c/w 25 of general
  population (USA)
• 40 of children excluded from primary education
  have symptoms of ADHD (USA)

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Classroom interventions

• A positive caring attitude
• Sit the child close to the teacher
• Chunking information
• Breaking tasks down into simple steps
• Reward good work and sustained attention with
• praise
• Using errands to help to break up the day
• Encourage participation in activities which
• promote self confidence and social skills

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ADHD Prognosis I

• - By age 4 a diagnosis is likely to persist
• into school age.
• - From childhood into adolescence approx. 50
  continue to meet diagnostic criteria.
• - From adolescence into adulthood 20-30 still
  meet diagnostic criteria and approx 60 have 1 or
  more core symptoms.

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ADHD in adults Attention problems

• Easily sidetracked, overlooking details, making
• careless mistakes, spelling and arithmetic
• errors, missing motorway exits.
• Lose track of conversations/meetings/lectures.
• Poor task planning and personal organisation.
• Forgetful, losing wallets/passports, failing to
• attend meetings or being late.

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ADHD in adults Impulsivity

• Difficulty waiting, poor frustration
• tolerance
• Take unnecessary risks when driving
• Blurting out inappropriate comments at
• work/home

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ADHD in Adults Hyperactivity

• Not always present in adults
• Some find it hard to be still for long
• periods, squirming and fidgeting in
• lectures/cinema etc.

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ADHD in adults Emotional

• Mood swings
• Irritability
• Low frustration tolerance
• React poorly to stress
• More easily become depressed

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ADHD Prognosis II

• Increased risk of developing ASPD (approx 20)
• Increased risk of substance misuse problems
  (15-20)
• Increased risk of suicide
• Educational underachievement
• Inconsistent work history
• Low self esteem

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Young Adults with untreated ADHDexperience

• More life threatening accidents
• More frequent assaults
• Increased risk of STDs and unplanned pregnancies
• Higher rates of unemployment
• Increased rates of relationship problems
• Increased chance of psychiatric care for other
  difficulties

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ADHD Positives!!!

• Quick witted and lively
• Creative drive
• Immediate problem solving skills
• Fun to be around

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ADHD - Management

• Non Medical
• Parent training
• Individual/group/family therapy
• Educational/remedial interventions
• Diet (young children)
• Medical
• Stimulants e.g. methylphenidate
• Non stimulant e.g. Atomoxetine, Clonidine,
  Risperidone.

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How do medicines work?

• We do not really know the answer.
• One theory is that the ADHD brain requires more
  stimulation to remain active, i.e. those with
  ADHD demonstrate increased activity and seek
  stimulation (distractions) to stay awake.
• Medicines may stimulate those parts of the brain
  reducing the individuals need for external
  stimulation.

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ADHD - Drugs

• Methylphenidate (Ritalin) derivative of
• amphetamine.
• In use since 1937, proven safe and effective.
• Increases availability of chemical
• messengers in the brain.
• Improves attention concentration and to a
• lesser extent impulsivity
• Common SEs are nausea, anxiety,
• headaches, reduced appetite.
• Twice or thrice daily dosing.

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ADHD - Drugs

• Concerta XL, Equasym XL, Medikinet XL
• Slow release formulations of
• methylphenidate designed to cover the
• school day.
• Once daily dosing

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ADHD - Drugs

• Atomoxetine
• Originally designed as an antidepressant
• works by increasing the availability of
• chemical messengers in the brain.
• Used when stimulants are ineffective,
• comorbid tic disorder or concerns about
• abuse.
• Slower onset of action 2-6 weeks
• Once or twice daily dosing

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ADHD 2nd Line Drugs (unlicensed)

• Clonidine, Modafinil, Imipramine,
• Pemoline show reasonable superiority to
• placebo in clinical trials.
• To be used only under specialist
• guidance.

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ADHD Managing Stimulant Medication

• Careful monitoring during initiation
• Use lowest effective dose
• Review BP 3 monthly
• Review Growth (height and weight) 6
• monthly
• Monitor for side effects
• Annual drug holiday recommended

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FAMOUS PEOPLE WITH ADHD

• Albert Einstein Bill Gates
• Sir Alexander Graham Bell Tom Cruise
• Salvador Dali Pablo Picasso
• Mozart Emily Dickinson
• Elvis Presley Edgar Allan Poe
• Zsa Zsa Gabor Rockefellar
• Virginia Woolf Stephen Hawking
• Alfred Hitchcock Vincent Van Gogh
• Leonardo Da Vinci Henry Ford

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If I Had My Child to Raise Over Again If I had
my child to raise all over again,I'd build self
esteem first, and the house later.I'd
fingerpaint more, and point the finger less.I
would do less correcting and more connecting.I'd
take my eyes off my watch, and watch with my
eyes.I would care to know less and know to care
more.I'd take more hikes and fly more kites.I'd
stop playing serious, and seriously play.I would
run through more fields and gaze at more
stars.I'd do more hugging and less tugging.I'd
see the oak tree in the acorn more often.I would
be firm less often, and affirm much more. I'd
model less about the love of power,And more
about the power of love. Diane Loomans
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Questions
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Want a hard copy?

• Then get in touch
• Eleanor.Adams_at_telfordpct.nhs.uk