Attention Deficit Hyperactivity Disorder

Today’s topic we’re going to talk about attention deficit disorder / hyperactivity disorder.  In these cases the patient complains of not having the ability to focus or the teacher or parent notices that the child does not seem to be able to listen when you are talking to them, it’s like if you were talking to a wall; because even though the child is looking at you their mind is somewhere else. These type of children avoid doing any task that requires attention and detail

 

 

 

Patients can be anywhere from pre-k to adult, some patients go on without being diagnosed until they are adults. The diagnosis is made mainly once the symptoms interfere with the patient’s ability to function or develop and it shows mostly at school and with adults in their work.

These individuals tend to lose their keys, books, tickets, passports, phones, everything seems to always be lost and they spend a lot of time in their lives looking for their personal items because they’re constantly being misplaced, they have a lack of detail ability.

 

These individuals tend to be disorganized if you look at their rooms, their car, their office is a mess and they learn to function within their disorganization. They have difficulty keeping assignments, keeping schedule, most of the time they’re late for appointments, they forget to return phone calls, pay bills.

 

A child having difficulty in school, never diagnosed is labeled as troublemaker, because the child does not have the ability to concentrate or focus on school work due to his ATTENTION DEFICIT DISORDER.   The child begins the class by paying attention for a very short span, then his mind automatically wanders off and when the child’s mind returns to the class, the class is way ahead of him; this makes it very difficult for the child to learn.

When the child does homework by himself, he tend to play with the pencil, pen, phone, computer, books, ect… they are unable to concentrate, taking a long time to do their homework.

 

Once the child is treated, they respond remarkably well in the school setting.

 

One thing that needs to be clarified is that attention deficit is completely separate from intelligence, a child can be very intelligent and still have attention deficit.

 

Attention Deficit Disorder is a life time illness, it does not go away like a cold.  You are able to adapt to lack of concentration by making lists reminders, using alarm clocks, anything that may help you stay within the norm that is expected at work or school.

 

Hyperactivity

 

Hyperactivity is an additional extension of Attention Deficit Disorder. In these cases the child is seen in pre-k and cannot sit still for one second, he’s constantly going from one child to the other to the teacher to the wall to the window and just cannot sit still or stop talking. Once the child makes it past pre-K, they tend to become intruders in conversation and games, they take personal things from other children without asking , they answer questions before they are addressed, they answer questions before the question has been completed, they talk excessively.

 

Usually hyperactivity tends to decrease as children get older, but the attention deficit persists into their adult life.

 

It’s important that once an individual has been diagnosed with attention deficit disorder that he or she understands the course of their illness so that it can be corrected appropriately. Knowing so the individual must learn to improve with their planning and address their poor impulsivity which are factors that tend to continue into adult life.

 

The prevalence of attention deficit disorder in our population is about 5% and in adults about 2.5%. 5% in children and 2.5% in adults. The positive note of this illness is that it responds very well to medication.

 

Treatment and Medications

 

Pharmacological treatment for ADHD and or ADD, consist of medications such as:

 

  • Ritalin
  • Addeerall
  • Focalin,
  • Evekeo (Which is the latest one in the market)

 

All the medications are very beneficial for patients with a ADD or ADHD, attention deficit disorder or attention deficit disorder with hyperactivity.

 

Not all patients have both diagnosis, some patients have both the attention deficit and hyperactivity and others only the attention deficit disorder.

 

The medications do have some side effects that need to be looked up on when given to each patient such as increasing high blood pressure, loss of appetite, patients with history of seizure disorder need to be looked at closely because the medications tend to lower the threshold on these type of patience with seizures. Blurring of the vision can be another side effect, again all these are side effects that could be present in anyone that might be taking medications, it does not necessarily mean that you’re going to have the side effect, as a consequence of taking the medications, some patients will develop side effects, but not necessarily in the majority of patients.

 

Patients with pre-existing psychotic disorder these medication can exacerbate the symptoms. Overall the majority of the patients responded very well to the treatment of medication with the above-mentioned pharmacological agents such and Focalin Adderall Ritalin and Evekeo.

 

Other medications used mostly in children are

 

  • Concerta
  • Strattera
  • Intuniv

 

The treatment for a ADD and ADHD consist of two group of medications:

 

  • The Stimulant Medications
  • Non Stimulant Medications.

 

In the stimulant category we have:

 

dextroamphetamine which are:

 

– Adderall

– Adderall XR

– Dexedrine

– Procentra

– Zenzedi

 

Adderall comes in two classes:

– The short acting which lasts about three to four hours depending on how fast you metabolize in medication

 

-The extended release or the XR with glasses about 8 to 10 hours.

 

Adderall comes in doses of :

 

  • 5 milligrams
  • 10 milligrams
  • 5 milligrams
  • 15 milligrams
  • 20 milligrams

 

Adderall XR which is long-acting comes in:

 

– 10 milligrams

– 15 milligrams

– 20 milligrams

– 25 milligrams

– 30 milligrams

 

Both medications work very well whether its short acting or long acting, it depends on what you want to accomplish or how you want to accomplish taking the medication .

 

The short acting has the advantage that you can take the medication only for 3 to 4 hours and you can go on with the rest of your day as if you had not taken any medication and does not affect your appetite, as we are well aware all the stimulants do tend to curb your appetite, more to some individuals than others

 

Dexedrine comes in:

 

– 5 milligrams

– 10 milligrams

– 15 milligrams .

 

Dexmethylphenidate is generic for Focalin and Focalin XR

 

Focalin (Short Acting) comes in tablets of:

  • 5 milligrams
  • 5 milligrams
  • 10 milligrams

 

Focalin xr (Longer acting) comes in capsules of

 

-5 milligrams

-10 milligrams

-15 milligrams

-20 milligrams

-25 milligrams

-30 milligrams

 

It comes in a capsule because this way it can give you the more extended release versus the Focalin that comes in tablets for an immediate release.

 

Methylphenidate is generic for Concerta, Daytrana, Metadate CD and Metadate ER

 

Concerta which is the most commonly used comes in:

  • 18 milligrams
  • 27 milligrams
  • 36 milligrams
  • 54 milligrams

 

Usually patients start in a lower dosage of 18 milligrams and slowly are worked up up to 54 milligrams according to how many milligrams the patient needs the medication to be able to improve the concentration.

 

Methaline and Methaline ER are the generic names for Ritalin and Ritalin SR,

 

Ritalin LA, Quillivant XR this a long-acting or extended release medications that last about 8 to 12 hours depending on how fast the patient metabolizes the medication.

 

Ritalin (short acting) comes in:

 

-5 milligrams

-10 milligrams

-20 milligrams

 

The long-acting of the generic comes in

 

– 10 milligrams

– 20 milligrams

– 30 milligrams

– 40 milligrams the

 

Ritalin SR comes in 20 milligrams.

 

Another long acting stimulant is lisdexamfetamine which is the generic for Vyvanse because it’s another a long-acting medication a stimulant it comes in capsules.

 

Vyvanse comes in

 

– 20 milligrams

– 30 milligrams

– 40 milligrams

– 50 milligrams

– 60 milligrams

– 70 milligrams.

 

Non Stimulant Medications

 

Atomoxetine generic for strattera which comes in 10 18, 25, 40, 60, and 80 milligrams .

 

Clonadine generic for Kapvay is also approved for use in ADD to be used in combination with other stimulus or it can be used by itself.

 

Guanfacine generic for Intuniv is a medication that it’s approved more for children from ages 6 to 17 and it’s a medication that is helpful in the sense that children tend to lose appetite with a stimulant and it in pairs of growth again in some children not in all of them. Therefore Intuniv becomes helpful for those situations where there is a problem with appetite.

 

This finalized is the psychopharmacol treatment for a ADD and ADHD

 

Don’t hesitate to leave us your comments and questions

 

All the best !