ADHD
ADHD Cont.
Depression
Extra
Autism
100

Treatment

Behavior Modification- 

Family Support

Pharmacology in preferred order: 

Psychostimulants

Alternate psychostimulant

Pemoline

Antidepressant

Alternate antidepressant

clonidine

100

Psychostimulant dosing

Methylphenidate- starting dosing 5-10 mg before breakfast and lunch, sometimes 3-4pm

Amphetamine/Dextroamphetamine-starting (Adderall) dose 2.5-5mg typically dosed twice daily (morning and noon)

Doses should not exceed 2mg/kg/d for

Methylphenidate and 1mg/kg/day for

Amphetamine/Dexampheramine

100

What are some causes or factors that may place a child at risk for depression

5% of US children and adolescents have depression

~ ½ with depression do not seek treatment, less than 20% get the help they need

Early onset mood disorders associated with turbulent, dysfunctional lives, poor school performance, impaired peer and family relationships, alcohol/substance abuse, and other psychiatric comorbidities

100

Depression Screening and what age does this start? 

Patient Health Questionnaire Depression Scale (adolescents, age 11) (PHQ-9) - <5minutes

Pediatric Symptom Checklist (PSC-Y) – children and adolescents - < 5minutes

Must determine if depression places patient at immediate risk for: Psychosis, Suicide,Volatile, Extremely aggressive, or at risk for ongoing abuse or neglect if returned to home environment

100

What we know about autism

Lifelong disability

Characterized by problems in 3 areas: Communication, behavior, social skills

Developmental disability

Occurs mostly in males

Occurs in 1 out of 250 live births

Manifest between age 18 months and 3 years

200

Charcteristics

Inattention:

Lack of detail orientation, difficulty staying on

track, looses things, difficulty organizing, forgetful.

Hyperactivity:

Cannot sit still, talks excessively, moves often

Impulsivity:

Cannot wait turns, interrupts/intrudes, blurts

out answers.

200

ADHD Follow up

Have parents keep logs of symptoms

Phone f/u after 1 week. may be needed until dose stable and no longer titrating

See 1 month after starting therapy and monthly until dose stable and no weight loss

Stable visits every 3-4 months.

200

Remission chances

Once a child experiences depression, he/she is at significant risk for developing another depressive episode in the next 5 years

74% remission in 1 year, 72% with 5 years.

200

Depression Treatment and what is considered the first line treatment

Psychotherapy plus medications is most effective

Long term success with treatment hinges on appropriate use of psychotherapy.

Cognitive and behavioral therapy

Need referral to a psychiatric specialist trained in pediatrics

First line treatment in children is considered to be therapy

200

Common Characteristics

Lack of awareness of the existence or feelings of others

Severe impairment in the ability to relate to others

Aloof and distant from others

Appears not to listen when spoken to

300

Epidemiology 

Environmental influences

Maternal tobacco &/or alcohol use, fetal distress, low birth weight.

Altered self-esteem

Genetics are believed to be related to effects on dopamine & norepinephrine

Inattention and distraction seem to be related to

low levels of norepinephrine

Impulsivity and behavior problems appear to be

related to low levels of dopamine

300

Psychostimulant side effects

Significant side effects include anorexia and insomnia

Can increase/cause tics

300

Comorbidities

Anxiety disorder

ADHD

Conduct, learning and oppositional defiant disorders

SAD

Eating disorders

Stress

300

Gold Standard for Assessing Autism

ADOS: Autism Diagnostic Observation Schedule, 

Accurately assess and diagnose autism and pervasive developmental disorders across ages, developmental levels, and language skills for toddler to adults, takes aprox. 45 mins

300

Social Skills

Fails to produce appropriate facial expressions to specific occasions

Avoids eye contact

Difficulty with changes in environment and routine

Does not seek opportunities to interact with others

Unwillingness and/or inability to engage in cooperative play

400

3 Types of ADHD

ADHD combined type if both criteria for hyperactivity/impulsiveness and inattention in the last 6 months

ADHD Inattention subtype if criteria met for inattention only in last 6 months

ADHD hyperactive/impulsive subtype if

criteria met for this only in last 6 months

400

Behavior Modification Suggestions

Change classroom seat, office layout

School folders

Chore charts 

career planning

Removing stimulation during tasks that require concentration

CBT

Parenting/ family support and education

400

Diagnosing Criteria and standard test used to identify this criteria. 

5 or more symptoms (most of the day, nearly every day) have been present during the same 2-week period, and represent a change from previous function:

Must have 1 of these:

Depressed mood- either subjective report or observations made by others

Marked diminished interest or pleasure in all, or almost all, activities

Significant weight loss when not dieting, weight

gain, or decrease in appetite (in kids-failure to

make expected weight gains).

Insomnia or hypersomnia

Psychomotor agitation or retardation (observable by others)

Fatigue or loss of energy

Feelings of worthlessness or excessive or inappropriate guilt

Diminished ability to think or concentrate, or indecisiveness

Recurrent thoughts of death


The PHQ-9 is the standard test 

400

Autism Treatment

Autism is not a disease; therefore there is not a single treatment or therapy

Individualized plans designed to meet the child’s needs

400

Communication Skills

Difficulties in using and understanding both verbal and non-verbal language

Failure to initiate or sustain conversational interchange

Abnormalities in the pitch, stress, rate, rhythm, and intonation of speech

Poor receptive and expressive skills

May echo words

Mays use screaming, crying, tantrums, aggression, or self-abuse as ways to communicate.

Repeating words or phrases in place of normal, responsive language.

500

Screening

Vanderbilt scale

Connor rating scales

500

Psychostimulant treatment assessment and follow up

Need baseline BP, pulse, height and weight to rule out contraindications and for growth and monitoring.

Need annual assessment

Assess weight and objective measurement of loss of appetite at each visit. Also screen for insomnia, headaches, social withdrawal, and tics.

500

Clinical presentation: Children vs Adolescence 

Diagnosis: children

Depressed mood may appear as irritable

mood. Children have more somatic

complaints, comorbid anxiety, agitation,

separation anxiety, and behavioral

problems.


Diagnosis: Adolescents

More antisocial behavior, substance use,

restlessness, grouchiness, aggression,

withdrawal, sexual promiscuity, problems

with family/school, wanting to leave home,

& of not being understood, appreciated.

500

What disease will you see perianal skin tags on PE? 

Chrons disease

500

Behavioral Skills

Unusual and repetitive movements of the body that interfere with the ability to attend to tasks or activities, such as hand flapping, finger flicking, grimacing.

Marked distress over changes in seemingly trivial aspects of the environment

Laughing or crying or showing distress for reasons not apparent to others.

Unreasonable insistence on following routines in precise detail.

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