Patterns in ADHD

1
Patterns in ADHD

• Leonid Topper, MD
• Pediatric Neurology Associates, P.A.

2
How to measure the diagnosis

• For meningitis you count cells
• For diabetes you measure glucose
• For anemia you check hemoglobin
• For IBS you count BMs
• ..
• For ADHD you count lines

3
Use Proper Tools

• The American Academy of Pediatrics
• and
• The National Initiative for Children's
  Healthcare Quality Caring for Children with
  ADHD A Resource Toolkit for Clinicians ADHD
  Online Resources
• Primary Care Initial Evaluation Form
• Vanderbilt assessment

4
Patterns - parents

• This is my last resort
• - risks of untreated ADHD
• She will have side effects
• - the risk of serious SE is
• Teacher told me to come he is a boy
• Give me prescription, see you next year
• Teachers didnt return the forms
• He is still talking back
• - tell me what, and Ill ask you
  when
• Attention is way worse than before the medicine

5
How to present the treatment

• 504, Fish oil
• - Assess the effectiveness same way as for
  medications
• Separate trial from actual treatment
• Decision point is after the trial, not before
• Warn about legwork, do not start too early
• How to deal with divorced parents, when He is
  against, and She cannot take it

6
Patterns - pediatricians

• Rules of conversion 21
• - strong and weak stimulants
• Short acting Short acting Long acting
• - think in mg/kg/hour, like IV drip
• 4 dose levels (25 max, 50 max, 75 max, and
  maximal dose)
• Insomnia move it up or switch
• Anorexia Dinner number 2 at bedtime.

7
Patterns in kids

• Im fine
• 0/9 on questionnaires
• - denial lags 1-2 years behind parents
• I like to do only what Im interested in
• Im stupid and worthless
• Im old enough to take my pills
• - how to deliver the medicine
• I want to try patch

8
Recognize trouble

• Migraine is worse
• Moodiness is severe
• Tics
• Depression
• Doesnt feel safe in school
• Wrong diagnosis (Aspergers, for example)
• Heart disease or complaints