Attention Deficit Hyperactivity Disorder - PowerPoint PPT Presentation

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Attention Deficit Hyperactivity Disorder


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Title: Attention Deficit Hyperactivity Disorder

Attention Deficit Hyperactivity Disorder
Kevin Leehey M.D.
  • 1980 E. Fort Lowell Rd. Suite 150
  • Tucson, AZ 85719
  • 520-296-4280 fax 520-296-3835
  • http//

Attention Deficit Hyperactivity Disorder
  • ADHD Inattentive Type
  • ADHD Hyperactive/Impulsive Type
  • ADHD Combined Type

Kevin Leehey, M.D. 296-3835
Differential Diagnosis
  • Medical or neurologic or other psychiatric
    conditions, such as hyperthyroidism, medication
    side-effects, anxiety disorders, post traumatic
    stress, depression, immature character, and
    oppositional behaviors, may look like ADHD but
    not actually be ADHD.

Kevin Leehey, M.D. 296-3835
  • Anxiety disorders, Tourettes Syndrome,
    depression, post traumatic stress difficulties,
    behavioral problems, learning difficulties,
    coordination disorders, sensory integration
    disorders, PDD, etc.
  • The most common condition associated with ADHD is
    a learning disorder (about 50 percent)

Kevin Leehey, M.D. 296-3835
Diagnostic Criteria
  • A.
  • Six (or more) of the symptoms of inattention
    have persisted for at least six-months to a
    degree that is maladaptive and inconsistent with
    developmental level
  • Or six (or more) of the symptoms of
    hyperactivity-impulsivity have persisted for at
    least six-months to a degree that is maladaptive
    and inconsistent with developmental level

Kevin Leehey, M.D. 296-3835
  • Often fails to give close attention to details or
    makes careless mistakes in schoolwork, work, or
    other activities
  • Often has difficulty sustaining attention in
    tasks or play activities
  • Often does not seem to listen when spoken to
  • Often does not follow through on instructions and
    fails to finish schoolwork, chores, or duties in
    the workplace (not due to oppositional behavior
    or failure to understand instructions)
  • Often has difficulty organizing tasks and
  • Often avoids, dislikes, or is reluctant to engage
    in tasks requiring sustained mental effort (such
    as schoolwork or homework)
  • Often loses things necessary for tasks or
    activities (ie toys, school assignments,
    pencils, books, or tools)
  • Is often easily distracted by extraneous stimuli
  • Is often forgetful in daily activities

Kevin Leehey, M.D. 296-3835
Hyperactivity Impulsivity
  • Often fidgets with hands or feet and squirms in
  • Often leaves seat in classroom or in other
    situations in which remaining seated is expected
  • Often runs about or climbs excessively in
    situations in which it is inappropriate (in
    adolescents or adults, may be limited to
    subjective feelings of restlessness)
  • Often has difficulty playing or engaging in
    leisure activities quietly
  • Is often on the go or often acts as if driven
    by a motor
  • Often talks excessively
  • Often blurts out answers before questions have
    been completed
  • Often has difficulty awaiting his/her turn
  • Often interrupts or intrudes on others (eg butts
    into conversations or games)

Kevin Leehey, M.D. 296-3835
More Diagnostic Criteria
  • B. Some hyperactive-impulsive or inattentive
    symptoms that caused impairment were present
    before age seven years
  • C. Some impairment from the symptoms is present
    in two or more settings (ie school, work, home)
  • D. There must be clear evidence of clinically
    significant impairment in social, academic, or
    occupational functioning
  • E. The symptoms do not occur exclusively during
    the course of a Pervasive Developmental Disorder,
    Schizophrenia, or other Psychotic Disorder and
    are not better accounted for by another mental
    disorder (ie Mood Disorder, Anxiety Disorder,
    Dissociative Disorder, or a Personality Disorder)

Making the Diagnosis
  • ADHD is often diagnosed based on meeting at least
    the minimum criteria for ADHD from DSM-IV
  • Psychological testing, WISC-IV,
  • Rating scales such as the Connors or SNAP
  • Continuous Performance Task Tests
  • Observation of the child or adolescents behavior
    in school and non-school settings
  • Family history

Kevin Leehey, M.D. 296-3835
Making the Diagnosis
  • Making the diagnosis for adults and preschoolers
    is more difficult. Many of the diagnostic
    criteria are described in terms most relevant for
    elementary, middle school, and less so, high
    school age groups. For adults, past history and
    data regarding school experiences and testing is
    often crucial (along with current and past
    functioning and family history).

Kevin Leehey, M.D. 296-3835
ADHD trends
  • 8 years old, third grade
  • Sixth grade, middle school
  • 3X Boys - wrong
  • Missed - girls, minorities, ODD, inattentive
    only, bright, co-morbid, mild
  • 5-7 of school age youth

Kevin Leehey, M.D. 296-3835
ADHD is more difficult to diagnose in preschool
  • A wider range of behavior is expectable
  • Attention span normally increases with age, as
    does impulse control and a lessening of physical
  • Parenting styles and cultural norms vary markedly
    in this age group
  • Medication treatment is often less helpful and
    less researched
  • Other interventions are often worthwhile
  • ADHD will become more clear with time

Kevin Leehey, M.D. 296-3835
Executive Function Disorder
  • Disorganization and poor time management skills
  • Follow-through and carrying out plans
  • Getting schoolwork/homework done or turned in
  • Failure to complete or turn in assignments
  • Do (fully or partially) their assignments but
    fail to turn them in or lose them

Kevin Leehey, M.D. 296-3835
ADHD diagnosis myths
  • Video/computer games, television, movies
  • He/she can if he/she wants to
  • He/she is fine at home, or 11, or at the
  • Lazy, underachiever, unmotivated

Kevin Leehey, M.D. 296-3835
Prognosis, Outcome
  • ADHD can be mild, moderate, or severe
  • Learning disorders may also be mild, moderate, or
  • Associated conditions complicate
  • Ability of that youngsters family, school, and
    even that youngsters ability to adjust to
    his/her current developmental needs and to what
    is expected of him/her

Kevin Leehey, M.D. 296-3835
ADHD prognosis
  • Hyperactivity resolves for 50 around puberty
    75 by age 21
  • Inattention often persists
  • School of hard knocks
  • 25 have conduct disorders and or substance abuse
  • Higher risks MVA, job losses, relationship
    problems, depression, anxiety

Kevin Leehey, M.D. 296-3835
Basic Medical Principles
  • HP, labs, hearing, vision
  • Educational assessment
  • Experienced and well trained clinician
  • 365 days, 24/7
  • Individualize and fine tune treatment

Kevin Leehey, M.D. 296-3835
  • Individual Therapy
  • Self esteem and impulse control
  • Family Therapy
  • It is more difficult to parent a youngster with

Kevin Leehey, M.D. 296-3835
  • 3. School/Work
  • Special education, 504 Accommodation
  • Positive home-school communication
  • The transition from elementary to middle school
    and again from middle school to high school
  • Environmental manipulation
  • 4. Medication

Kevin Leehey, M.D. 296-3835
  • 5. Additional or Alternative treatments
  • Martial arts
  • Exercise/sports
  • Biofeedback (Neurofeedback)
  • Sensory integration treatment
  • Nutritious diet, sweets, junk food, sugar
  • Vitamins, herbs, and other supplements
  • Dyslexia is a language processing phonologic
    error in language areas of the brain, not a
    hearing or vision disorder

Kevin Leehey, M.D. 296-3835
Medications for ADHD-1
  • Stimulants
  • Methylphenidate
  • Short and extended duration
  • Amphetamines
  • Short and extended duration
  • Pemoline (Cylert)

Kevin Leehey, M.D. 296-3835
Medications for ADHD-2
  • Non-stimulants
  • Atomoxetine (Stattera)
  • Tricyclics (Imipramine, Desipramine)
  • Buproprion (Wellbutrin)
  • Partial alpha agonists Guanfacine (Tenex),

Kevin Leehey, M.D. 296-3835
Medications for ADHD-3
  • Combinations/polypharmacy
  • Avoid if possible
  • Stimulant and atomoxetine or other non-stimulant
    ADHD medication
  • Atomoxetine and SRI
  • Non psych medications
  • Stimulant plus SRI plus DDAVP is safer than
    desipramine alone

Kevin Leehey, M.D. 296-3835
Medications for ADHD-4
  • Out of the Box
  • amantadine (Symmetrel)
  • modafinil (Provigil)
  • pramipexole (Mirapex)
  • ropinirole (Requip)

Kevin Leehey, M.D. 296-3835
Medications for ADHD-5
  • Beads/sprinkle
  • Adderall XR, Ritalin LA, Metadate CD, Focalin XR
  • Liquid
  • Methylin, Amantadine (Symmetrel)
  • Chewable
  • Methylin
  • Patch
  • - Catapres, MPH (soon)
  • Osmotic pressure release
  • - Concerta
  • Compounding

Kevin Leehey, M.D. 296-3835
Prescribing for ADHD-1
  • Co-morbidity Depression, anxiety, tics,
    substances, bipolar, nicotine
  • Height, weight
  • Appetite decrease and low weight is the most
    common limiting stimulant side effect
  • Class II, no refills, 60 days, less on base
    post, out of state varies, 90 day mail order
  • Match side effects as well as good effects

Kevin Leehey, M.D. 296-3835
Prescribing for ADHD-2
  • Duration
  • Convenience
  • Weight (height less of a concern)
  • Tics
  • Meaner
  • Abuse of stimulants
  • Truck driver, pilot

Kevin Leehey, M.D. 296-3835
Prescribing for ADHD-3
  • Regular follow-up appointments
  • Not just med checks
  • Height, weight, growth curve
  • School, home, peers, activities, etc.
  • Patient and significant other input
  • Benefits and adverse effects

Kevin Leehey, M.D. 296-3835
Kevin Leehey M.D.
  • 1980 E. Fort Lowell Rd. Suite 150
  • Tucson, AZ 85719
  • 520-296-4280 fax 520-296-3835
  • http//
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