ADD - ADHD

• Adult ADD
• Diagnosis, Imaging, Screening
• General Information
• Guidelines
• Internet Sites
• Risk Factors
• Risk Reduction
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ADD - ADHD

NIH - Attention Deficit Hyperactivity Disorder "According to the most recent version of the Diagnostic and Statistical Manual of Mental Disorders2 (DSM-IV-TR), there are three patterns of behavior that indicate ADHD. People with ADHD may show several signs of being consistently inattentive. They may have a pattern of being hyperactive and impulsive far more than others of their age. Or they may show all three types of behavior. This means that there are three subtypes of ADHD recognized by professionals. These are the predominantly hyperactive-impulsive type (that does not show significant inattention); the predominantly inattentive type (that does not show significant hyperactive-impulsive behavior) sometimes called ADD—an outdated term for this entire disorder; and the combined type (that displays both inattentive and hyperactive-impulsive symptoms)."

NHS - Attention deficit hyperactivity disorder (ADHD) “Symptoms of ADHD in children and adolescents The symptoms of ADHD in children and adolescents are well defined. The main symptoms of each behavioural problem are detailed below. Inattentiveness • a very short attention span, • being very easily distracted, • being unable to stick at tasks that are tedious, or time consuming, • being unable to listen to, or carry out, instructions, • being unable to concentrate, and • constantly changing activity, or task. Hyperactivity • being unable to sit still, especially in calm or quiet surroundings, • constantly fidgeting, • being unable to settle to tasks, and • excessive physical movement. Impulsiveness • being unable to wait for a turn, • acting without thinking, • breaking any set rules, and • little or no sense of danger. If your child has ADHD, their symptoms usually become noticeable at around the age of five. ADHD can cause many problems in your child's life, and can often lead to underachievement at school, poor social interaction with other children and adults, and problems with discipline.“

Highlighted Articles

Identifying, Evaluating, Diagnosing, and Treating ADHD in Minority Youth (Journal of Attention Disorders 2008) “Untreated ADHD carries greater risk for substance abuse, impulsive behavior, and legal conflicts, whereas overdiagnosing and overtreating risk stigma associated with mental disorder, growth limitation, and tachycardia or hypertension. This dichotomy is even more perplexing for minority youth, many of whom are disadvantaged and lack access to care. Stressful living circumstances increase the likelihood a minority child will be diagnosed with ADHD (Barbarin & Soler, 1993). Fearing their child will be labeled, minority parents may hesitate to ask for help. … Cultural awareness during the assessment and history gathering is critical for the evaluation of minority youth. There are ADHD scales more appropriate for minority children. In addition, we are learning that children of diversity may not respond to all medications the same way Caucasian children do. The more we learn about genetic variations, the more we are likely to understand why medication alone is not effective in all cases and should not be considered the only treatment tool. Prosocial skills training, psychotherapy for the children, and support for the parents are all key if we want these children to truly succeed.”

ADHD in Children With Comorbid Conditions: Diagnosis, Misdiagnosis, and Keeping Tabs on Both (2007) "There is a complex interplay between ADHD and its commonly occurring comorbid psychiatric disorders, such as oppositional defiant disorder (ODD), conduct disorder (CD), anxiety, depression, bipolar disorder (BPD), and substance abuse. Comorbidity greatly influences presentation, diagnosis, and prognosis; complicates treatment; and significantly increases the morbidity and disease burden of ADHD.[6] When ADHD is comorbid with another psychiatric disorder, it is often the first disorder to develop, and children with severe ADHD symptoms have a higher likelihood of developing other psychiatric disorders.[1] When evaluating for comorbid conditions, the clinician should attempt to determine whether one "primary" condition can fully account for the most disabling and distressing symptoms. If a primary condition can fully explain such symptoms, then the other condition should not be diagnosed. For example, if a patient has ADHD symptoms only during episodes of bipolarity, ADHD would not be diagnosed. "

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Attention Deficit Disorder and Attention Deficit Hyperactivity Disorder

Daily Treatment Report

Cognitive Therapy-CBT-Psychotherapy

Drug Side-Effects and Interactions

The sleep of children with attention deficit hyperactivity disorder on and off methylphenidate: a matched case-control study. (J Sleep Res. 2009) “Our findings suggest that methylphenidate reduces sleep quantity but does not alter sleep architecture in children diagnosed with ADHD. An adequate amount of sleep is integral to good daytime functioning, thus the sleep side effects of methylphenidate may affect adversely the daytime symptoms the drug is targeted to control.”

Cardiac safety of methylphenidate versus amphetamine salts in the treatment of ADHD. (Pediatrics. 2009)

Methylphenidate, Amphetamine Salts Show Similar Cardiac Risks in Children With ADHD

Study Shows Possible Link Between Deaths and ADHD Drugs “Children taking stimulant drugs such as Ritalin to treat attention-deficit hyperactivity disorder are several times as likely to suffer sudden, unexplained death as children who are not taking such drugs, according to a study published yesterday that was funded by the Food and Drug Administration and the National Institute of Mental Health. While the numbers involved in the study were very small and researchers stopped short of suggesting a cause and effect, the study is the first to rigorously demonstrate a rare but worrisome connection between ADHD drugs and sudden death among children. In doing so, the research adds to the evolving puzzle parents and doctors face in deciding whether to treat children with medication.”

Atomoxetine: a review of its use in attention-deficit hyperactivity disorder in children and adolescents. (Paediatr Drugs. 2009) “Atomoxetine (Strattera(R)) is a selective norepinephrine (noradrenaline) reuptake inhibitor that is not classified as a stimulant, and is indicated for use in patients with attention-deficit hyperactivity disorder (ADHD). … Common adverse events included headache, abdominal pain, decreased appetite, vomiting, somnolence, and nausea. The majority of adverse events were mild or moderate; there was a very low incidence of serious adverse events. Few patients discontinued atomoxetine treatment because of adverse events. Atomoxetine discontinuation appeared to be well tolerated, with a low incidence of discontinuation-emergent adverse events. Atomoxetine appeared better tolerated among extensive CYP2D6 metabolizers than among poor metabolizers. Slight differences were evident in the adverse event profiles of atomoxetine and stimulants, both immediate- and extended-release. Somnolence appeared more common among atomoxetine recipients and insomnia appeared more common among stimulant recipients. A black-box warning for suicidal ideation has been published in the US prescribing information, based on findings from a meta-analysis showing that atomoxetine is associated with a significantly higher incidence of suicidal ideation than placebo.”

Atomoxetine treatment in adults with attention-deficit/hyperactivity disorder and comorbid social anxiety disorder. (Depress Anxiety. 2009)

Hallucinations and other psychotic symptoms associated with the use of attention-deficit/hyperactivity disorder drugs in children. (Pediatrics. 2009) CONCLUSIONS: Patients and physicians should be aware that psychosis or mania arising during drug treatment of attention-deficit/hyperactivity disorder may represent adverse drug reactions."

Drugs

Effect of Atomoxetine on Executive Function Impairments in Adults With ADHD. (J Atten Disord. 2009)

Management of attention-deficit hyperactivity disorder in adults: focus on methylphenidate hydrochloride (Neuropsychiatr Dis Treat. 2009)

Methylphenidate normalises activation and functional connectivity deficits in attention and motivation networks in medication-naïve children with ADHD during a rewarded continuous performance task. (Neuropharmacology. 2009)

Acute atomoxetine effects on the EEG of children with Attention-Deficit/Hyperactivity Disorder. (Neuropharmacology. 2009)

Dopaminergic and Noradrenergic Contributions to Functionality in ADHD: The Role of Methylphenidate. (Curr Neuropharmacol. 2008)

Atomoxetine for the treatment of attention-deficit/hyperactivity disorder in children and adolescents: a review. (Neuropsychiatr Dis Treat. 2009) “Atomoxetine (Strattera®; Eli Lilly and Company), a selective norepinephrine reuptake inhibitor (SNRI), is the only non-stimulant approved by the FDA for the treatment of ADHD in children, adolescents and adults. While stimulant class medications are frequently used as first-line agents, atomoxetine may also be considered as an initial choice, particularly in the presence of select comorbid disorders, including active substance abuse, anxiety disorder or tic disorder.2 … Mechanistically, inhibition of the NE transporter blocks synaptic clearance of NE, thereby increasing synaptic NE concentrations in noradrenergic pathways. For example, NE in prefrontal cortical (PFC) regions has been shown to play a key role in attention and higher cognitive processes.6 In animal studies, atomoxetine has been shown to selectively increase dopamine (DA) to a similar magnitude as NE in the PFC, due to region-specific shared monoamine uptake inhibition, while not altering DA in other dopamine-rich brain regions such as nucleus accumbens and striatum.6 In addition, atomoxetine robustly increased NE in other brain regions with a substantial density of norepinephrine transporters; atomoxetine rapidly and persistently increased norepinephrine in rat occipital cortex, lateral hypothalamus, dorsal hippocampus, and cerebellum.7”

Atomoxetine for the treatment of attention-deficit/hyperactivity disorder in children and adolescents: a review (Neuropsychiatric Disease and Treatment 2009)

Update on atomoxetine in the treatment of attention-deficit/hyperactivity disorder. (Expert Opin Pharmacother. 2009) “Background: Atomoxetine, an inhibitor of, the presynaptic transporter of norepinephrine, was approved for the treatment of attention-deficit/ hyperactivity disorder (ADHD) in children aged 6 years and older, adolescents and adults in the USA in 2002, and in Europe, first in the UK and then by mutual recognition in several countries during 2003 and 2004. Since that time, the use of atomoxetine has spread globally and extensive additional research has been conducted evaluating its efficacy and safety. Objective: The objective of this review is to provide a summary of the available data on atomoxetine, with an emphasis on postmarketing clinical research, which is helping to clarify the role of this agent in ADHD pharmacotherapy.”

Exercise

General Information

Management of attention-deficit hyperactivity disorder in adults: focus on methylphenidate hydrochloride (Neuropsychiatric Disease and Treatment 2009) “The Diagnostic and Statistical Manual for Mental disorders, Fourth Edition Text Revision (DSM-IV-TR) requires 6 out of 9 symptoms of inattention (ie, failure to attend to detail, difficulty sustaining attention, not listening when spoken to, failure to follow through on tasks, organizational deficits, difficulty concentrating, losing items, distractibility, forgetfulness) or hyperactivity/impulsivity (ie, fidgeting, difficulty staying seated, excessive running/climbing, difficulty playing quietly, acts as though “driven by a motor”, excessive talking, difficulty awaiting one’s turn, interrupting frequently, prematurely responding to questions) be present for a diagnosis of ADHD.1 In addition, the symptoms must be present before age 7 and result in significant impairment observable in at least two settings. The three ADHD subtypes according to DSM criteria are: predominantly hyperactive-impulsive type, inattentive type and combined type.1 However, it is important to note that the DSM criteria were developed based on childhood presentation and may not adequately represent symptoms in adults.9–14 The Utah criteria, developed for identification of adult ADHD, may be utilized as an alternative to DSM criteria. According to these criteria, an adult must have a childhood history of ADHD and current motor hyperactivity, attention deficits and 2 of the following: labile affect, temper outbursts, excessive emotional reactivity, disorganization, impulsivity and associated features of ADHD.15 … Adult ADHD causes academic, occupational and social dysfunction with significant economic burden to society. Currently, there are no national guidelines to aid physicians in the diagnosis and management of adult ADHD, and most of the treatment principles are based on evidence from childhood ADHD treatment. In spite of the advent of longer-acting and nonstimulant medications for the treatment of ADHD, MPH remains the most cost-effective treatment with clinically significant outcomes. Amid concerns for diversion of drugs for potential abuse, MPH (particularly short-acting, immediate-release MPH) has been shown to decrease substance use disorders in children and young adults. Long-acting preparations are beneficial because of their potential for increased compliance and lower potential for abuse. Compared with the childhood ADHD literature, there is a significant paucity of evidence on the cardiovascular and psychiatric adverse effects in adults. Further, there is limited evidence of the comparative efficacy, including long-term efficacy, and safety of different pharmacological agents. Until more data are available, immediate-release and long-acting MPH and other stimulant medications remain the mainstay of treatment for adult ADHD.”

Meta-Analysis: Treatment of Attention-Deficit Hyperactivity Disorder in Children With Comorbid Tic Disorders. (J Am Acad Child Adolesc Psychiatry. 2009)

Attention-Deficit/Hyperactivity Disorder Management Reviewed

[Training of executive function in preschool children with combined attention deficit hyperactivity disorder: a prospective, controlled and randomized trial] (Rev Neurol. 2009)

Guidelines

Internet Sites

Treatment Information

DrugBank (drug structure)

FDA - MedWatch (Drug Alerts)

Treating Attention Deficit Hyperactivity Disorder

Drug-Food-Supplement Information

Drug Information Online

Drug Interaction Checker

DrugDigest (drug interactions)

FDA - Drug Interactions: What You Should Know

NIH - Botanical Dietary Supplements: Background Information

NIH - Drug, Supplements, and Herbal Information

NIH - Herbal Supplements: Consider Safety, Too

NIH - Medicines

NIH - Vitamin and Mineral Supplement Fact Sheets

Nutrition

Other

Other Treatments

Experimental

Supplements-Vitamins-CAM

Nutrient supplementation approaches in the treatment of ADHD. (Expert Rev Neurother. 2009)

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