1 / 21

Pharmacological Treatment of Child & Adolescent ADHD

Pharmacological Treatment of Child & Adolescent ADHD. Baseline Measurement. WFIRSP CFA. CBC. Ht Wt BP Pulse. SNAP-IV 18. History. KSES-A. Complete blood count (CBC) Height; Weight; Blood Pressure; Pulse Rate SNAP-IV 18 Items Rating Scale

velika
Download Presentation

Pharmacological Treatment of Child & Adolescent ADHD

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Pharmacological Treatment of Child & Adolescent ADHD

  2. Baseline Measurement WFIRS\P CFA CBC Ht Wt BP Pulse SNAP-IV 18 History KSES-A • Complete blood count (CBC) • Height; Weight; Blood Pressure; Pulse Rate • SNAP-IV 18 Items Rating Scale • WFIRS-P (Weiss Functional Impairment Rating Scale- Parent Report) • CFA (Child Functional Assessment) • KSES-A (Kutcher Side Effects Scale for ADHD Meds) • Family history of heart disease

  3. Facts About Stimulants • Do not cause addiction in ADHD treatment • Tolerance develops occasionally • Decreases rates of future substance abuse • Improves outcomes in functioning • “Drug holidays” are not needed • Long acting, once per day dose easiest

  4. Stimulants & Non-Stimulants Stimulants Non-Stimulants Highly effective Available for decades Well studied Safe prescribed to healthy patients under medical supervision For youth… 1. Not responding well to stimulant medications 2. At risk for substance abuse 3.With other conditions with ADHD Available in two different forms Short-Intermediate Release Preparations Repeated doses/day More adverse effects Stigma associated with taking at school. Methylphenidate’s Ritalin® Ritalin® SR PMSor RatioMethylphenidate Dextroamphetamine Sulphate’s Dexedrine Extended Release Preparations Preferred over short-acting medications, Better compliance; less diversion. More expensive, not all Canadian medication insurance plans cover. Mixed Salts Amphetamine *Adderall XR Methylphenidate *Biphentin *Concerta *Novo-Methylphenidate ER-C Lisdexamfetamine Dimesylate *Vyvanse Atomoxetine *Strattera Is the only non-stimulant medication that is approved to treat children / adolescents withADHD.

  5. Additional ADHD Medications • Tricyclic antidepressants (not recommended) • Imipramine or Desipramine • Bupropion • Wellbutrin • Clonidine Reserve these medications for specialty mental health services

  6. “N of 1” Model • Evaluating response to Methylphenidate • 3-day baseline assessment • SNAP-IV 18 • Alternate every 3 days for 12 days: • Dose of methylphenidate (standard release) • 5 mg/BID or 10 mg/BID depending on weight • Dose of placebo • Daily measurement • Symptoms (SNAP-IV 18) • Side Effects (KSES-A)

  7. Stimulants Misuse • Concerning with alcohol/drug abuse • Careful evaluation and monitoring • Avoiding drug diversion • Sustained-release preparations • Non-stimulants • Consider using Atomoxetine • Studying for exams

  8. Collaborative Prescribing Agreement for ADHD Medications http://www.health.gov.bc.ca/pharmacare/sa/criteria/restricted/methylphenidate.html

  9. CADDRA Medication Tables

  10. Methylphenidate Treatment

  11. Dextroamphetamine Treatment

  12. Non-Stimulant Atomoxetine Treatment NOTE: If symptoms are not under optimal control with 1.2mg after maintaining it for at least 6 weeks refer to speciality service.

  13. Switching to Long Acting Forms … • When total daily dose is determined… • Switch to long acting form • Biphentin • Concerta • Nova-Methylphenidate ER-C • Single daily morning dose • Equivalent of initial Ritalin dose • Long acting Methylphenidate • Start at lowest dose; increase weekly • Essential to evaluate twice/wk • SNAP-IV • Side Effects Scale

  14. Switching to Atomoxetine • If switching for reasons other than side effects • Add Atomexetine until ADHD symptoms improve • Then stop Methylphenidate Use PST Based Supportive Rapport

  15. Kutcher Side Effects Scale for ADHD Meds

  16. Monitoring Treatment of Attention Deficit Hyper-Activity Disorder * For Stimulants Only

  17. Duration of Treatment Maintain treatment for defined length of time to: • Allow for further improvements in symptoms • Allow for additional therapeutic interventions to occur (e.g. CBT or parent training) • Decrease risk of relapse • Decrease risk of a co-morbid mental disorder

  18. Medication Adherence

  19. Checking Adherence to Treatment • Predict non-compliance • Openly recognize probability • Missing one or more doses of medication • No need to feel guilty • Occasional misses… …a little change in fluoxetine (long half-life) …a difference in missing sertraline (shorter half life)

  20. Assessing Treatment Adherence3 Methods • Enquire about medication use from child • Enquire about medication use from parent • Pill counts are sometimes useful

  21. If Relapse Occurs… • …evaluate the following • Compliance with treatment • Medical illness • Onset of stressors that challenge patient • Onset of substance abuse • Alternative diagnostic possibility • Depression, anxiety disorder, bipolar disorder • Refer to mental health specialist if relapse occurs despite adequate ongoing treatment

More Related