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ADHD: Management

by Brian Alverson, MD
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    00:01 So if a patient meets these criteria for attention deficit disorder or attention deficit hyperactivity disorder, there are some things we can do to help improve the circumstances.

    00:12 The first is around behavioral and family counselling.

    00:16 It’s important to establish some key goals for the family and the patient.

    00:21 For example, we can work on helping the family become more consistent with their parenting.

    00:27 Providing more positive reinforcement.

    00:29 Reducing distractions such as television watching or other things during tasks.

    00:36 Likewise, we can work on social skill modifications.

    00:40 This can be done with help from counsel or therapist.

    00:44 And it’s important to intervene with school as well.

    00:47 Schools are used to this problem.

    00:50 Frequently, parents and physicians may assist with the development of an individualized learning plan, which can create a better environment for that child in school.

    01:01 Examples might be altering the conditions of testing.

    01:05 They may be recording or using technology to record lessons so that kids can later refer to exactly what was going on.

    01:13 It may be they can get special instruction.

    01:16 So we can alter the educational environment too to really improve the way that child is doing in school.

    01:25 Additionally, physicians go through the decision process of whether or not to provide medications.

    01:31 This is a somewhat controversial thing, although stimulants are routinely used in the United States.

    01:38 It’s important though not to just rely on stimulants, but to address all aspects of care.

    01:44 However, stimulants are commonly used, so let’s go through it.

    01:47 So stimulants are in fact the first line therapy for attention deficit disorder.

    01:53 We can use short or long-acting stimulants depending on the behavioral pattern.

    01:58 So for instance if a child mostly only has troubles at certain times of the day, a short-acting stimulant at a certain time may be better or if it’s a really durational problem where it happens both at school or at home and it’s prolonged, a long-acting stimulant maybe your better choice.

    02:16 There are also some non-stimulants that may be beneficial to patients.

    02:21 Atomexetine is one possibility.

    02:24 However, these tend to be a little bit less effective.

    02:27 We usually employ them in cases where stimulants would have a substantial side effect profile that would hurt the patient.

    02:34 For example, a child with a bad tic disorder or anxiety problem, which is worsened by stimulants.

    02:41 The side effects of atomexetine include fatigue, somnolence or irritability.

    02:47 Additionally, we can turn to alpha-2 agonists.

    02:50 Examples are Clonidine or guanfacine.

    02:54 These do not cause tic exacerbation and are a little bit better for sleep disturbance.

    02:59 But they do cause sedation, so they might be a problem in school.

    03:03 They also cause dry mouth.

    03:05 We typically take these daily and they shouldn’t be stopped abruptly.

    03:10 They should be gradually weaned off if a decision is made to discontinue this therapy.

    03:16 So that’s my summary of attention deficit disorder in children.

    03:19 Thanks for your attention.


    About the Lecture

    The lecture ADHD: Management by Brian Alverson, MD is from the course Child Development and Behavior.


    Included Quiz Questions

    1. Atomoxetine
    2. Ranitidine
    3. Atomantium
    4. Ondansetron
    5. Benzodiazepine
    1. Family counseling, establish goals and reduce distraction during tasks.
    2. Social skill modification is not required.
    3. No educational interventional required.
    4. Change of environment is not required.
    5. Better parenting is of no use.
    1. irritability and somnolence.
    2. liveliness, hyperactivity.
    3. anxiety and manic episodes.
    4. OCD and headache.
    5. …depression.
    1. Alpha 2 blockers.
    2. Provide positive reinforcement.
    3. Social skill modifications.
    4. Reducing distractions.
    5. Short acting stimulant.

    Author of lecture ADHD: Management

     Brian Alverson, MD

    Brian Alverson, MD


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