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1980 E. Fort Lowell Rd. Suite 150 |
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Tucson, AZ 85719 |
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520-296-4280
fax 520-296-3835 |
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http://leeheymd.com |
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kevino@leeheymd.com |
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ADHD Inattentive Type |
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ADHD Hyperactive/Impulsive Type |
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ADHD Combined Type |
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ADHD NOS |
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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. |
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Anxiety disorders, Tourette’s Syndrome,
depression, post traumatic stress difficulties, behavioral problems,
learning difficulties, coordination disorders, sensory integration
disorders, PDD, etc. |
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The most common condition associated with ADHD
is a learning disorder (about 50 percent) |
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A. |
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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 |
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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 |
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Often fails to give close attention to details
or makes careless mistakes in schoolwork, work, or other activities |
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Often has difficulty sustaining attention in
tasks or play activities |
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Often does not seem to listen when spoken to
directly |
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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) |
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Often has difficulty organizing tasks and
activities |
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Often avoids, dislikes, or is reluctant to
engage in tasks requiring sustained mental effort (such as schoolwork or
homework) |
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Often loses things necessary for tasks or
activities (ie: toys, school assignments, pencils, books, or tools) |
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Is often easily distracted by extraneous stimuli |
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Is often forgetful in daily activities |
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Often fidgets with hands or feet and squirms in
seat |
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Often leaves seat in classroom or in other
situations in which remaining seated is expected |
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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) |
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Often has difficulty playing or engaging in
leisure activities quietly |
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Is often “on the go” or often acts as if “driven
by a motor |
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Often talks excessively |
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Often blurts out answers before questions have
been completed |
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Often has difficulty awaiting his/her turn |
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Often interrupts or intrudes on others (eg:
butts into conversations or games) |
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B. Some
hyperactive-impulsive or inattentive symptoms that caused impairment were
present before age seven years |
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C. Some impairment from the symptoms is
present in two or more settings (ie: school, work, home) |
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D. There must be clear evidence of clinically
significant impairment in social, academic, or occupational functioning |
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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) |
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ADHD is often diagnosed based on meeting at
least the minimum criteria for ADHD from DSM-IV |
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Psychological testing, WISC-IV,
Woodcock-Johnson-R |
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Rating scales such as the Connors or SNAP |
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Continuous Performance Task Tests |
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Observation of the child or adolescent’s
behavior in school and non-school settings |
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Family history |
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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). |
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8 years old, third grade |
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Sixth grade, middle school |
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3X Boys - wrong |
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Missed - girls, minorities, ODD, inattentive
only, bright, co-morbid, mild |
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5-7% of school age youth |
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A wider range of behavior is expectable |
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Attention span normally increases with age, as
does impulse control and a lessening of physical hyperactivity |
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Parenting styles and cultural norms vary
markedly in this age group |
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Medication treatment is often less helpful and
less researched |
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Other interventions are often worthwhile |
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ADHD will become more clear with time |
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Disorganization and poor time management skills |
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Follow-through and carrying out plans |
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Getting schoolwork/homework done or turned in |
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Failure to complete or turn in assignments |
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Do (fully or partially) their assignments but
fail to turn them in or lose them |
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Video/computer games, television, movies |
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“He/she can if he/she wants to” |
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“He/she is fine at home”, or 1:1, or at the
office |
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“Lazy”, underachiever, unmotivated |
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ADHD can be mild, moderate, or severe |
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Learning disorders may also be mild, moderate,
or severe |
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Associated conditions complicate |
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Ability of that youngster’s family, school, and
even that youngster’s ability to adjust to his/her current developmental
needs and to what is expected of him/her |
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Hyperactivity resolves for 50% around puberty;
75% by age 21 |
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Inattention often persists |
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“School of hard knocks” |
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25% have conduct disorders and or substance
abuse |
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Higher risks MVA, job losses, relationship
problems, depression, anxiety |
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H&P, labs, hearing, vision |
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Educational assessment |
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Experienced and well trained clinician |
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365 days, 24/7 |
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Individualize and fine tune treatment |
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Individual Therapy |
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Self esteem and impulse control |
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Family Therapy |
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It is more difficult to parent a youngster with
ADHD |
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3.
School/Work |
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Special education, 504 Accommodation |
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Positive home-school communication |
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The transition from elementary to middle school
and again from middle school to high school |
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Environmental manipulation |
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4.
Medication |
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5. Additional or Alternative treatments |
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Martial arts |
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Exercise/sports |
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Biofeedback (“Neurofeedback”) |
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Sensory integration treatment |
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Nutritious diet, sweets, “junk food”, sugar |
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Vitamins, herbs, and other supplements |
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“Dyslexia” is a language processing phonologic
error in language areas of the brain, not a hearing or vision disorder |
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Stimulants |
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Methylphenidate |
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Short and extended duration |
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Amphetamines |
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Short and extended duration |
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Pemoline (Cylert) |
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Non-stimulants |
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Atomoxetine (Stattera) |
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Tricyclics (Imipramine, Desipramine) |
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Buproprion (Wellbutrin) |
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Partial alpha agonists [Guanfacine (Tenex),
Clonidine] |
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Combinations/polypharmacy |
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Avoid if possible |
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Stimulant and atomoxetine or other non-stimulant
ADHD medication |
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Atomoxetine and SRI |
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Non psych medications |
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Stimulant plus SRI plus DDAVP is safer than
desipramine alone |
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Out of the Box |
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amantadine (Symmetrel) |
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modafinil (Provigil) |
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pramipexole (Mirapex) |
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ropinirole (Requip) |
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Beads/sprinkle |
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Adderall XR, Ritalin LA, Metadate CD, Focalin XR |
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Liquid |
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Methylin, Amantadine (Symmetrel) |
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Chewable |
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Methylin |
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Patch |
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- Catapres,
MPH (soon) |
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Osmotic pressure release |
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- Concerta |
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Compounding |
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Co-morbidity: Depression, anxiety, tics,
substances, bipolar, nicotine |
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Height, weight |
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Appetite decrease and low weight is the most
common limiting stimulant side effect |
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Class II, no “refills”, 60 days, less on base
post, out of state varies, 90 day mail order |
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Match side effects as well as good effects |
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Duration |
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Convenience |
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Weight (height less of a concern) |
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Tics |
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“Meaner” |
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Abuse of stimulants |
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Truck driver, pilot |
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Regular follow-up appointments |
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Not just “med checks” |
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Height, weight, growth curve |
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School, home, peers, activities, etc. |
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Patient and significant other input |
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Benefits and adverse effects |
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1980 E. Fort Lowell Rd. Suite 150 |
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Tucson, AZ 85719 |
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520-296-4280
fax 520-296-3835 |
|
http://leeheymd.com |
|
kevino@leeheymd.com |
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