ADHD: Management

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.