by ryan raroque case study 46: attention deficit/hyperactivity disorder
TRANSCRIPT
By Ryan Raroque
Case Study 46: Attention Deficit/Hyperactivity Disorder
What is ADHD?
Psychological disorder that involves significant, age inappropriate issues with any or all of the following:
AttentionHyperactivityImpulsivity
Mother’s Chief Complaints-“I’m at the end of my rope and don’t know what to do anymore”
Mother’s Chief Complaints-“I’m at the end of my rope and don’t know what to do anymore”
-He won’t behave in school or listen at home
Mother’s Chief Complaints-“I’m at the end of my rope and don’t know what to do anymore”
-He won’t behave in school or listen at home
-He’s always in motion and can’t sit still for five minutes
Mother’s Chief Complaints-“I’m at the end of my rope and don’t know what to do anymore”
-He won’t behave in school or listen at home
-He’s always in motion and can’t sit still for five minutes
-He likes watching cartoons but gets bored in a matter of minutes
Mother’s Chief Complaints-“I’m at the end of my rope and don’t know what to do anymore”
-He won’t behave in school or listen at home
-He’s always in motion and can’t sit still for five minutes
-He likes watching cartoons but gets bored in a matter of minutes
Mother’s Chief Complaints-His first grade teacher says he can’t sit still at schooland constantly squirms in his seat
Mother’s Chief Complaints-His first grade teacher says he can’t sit still at schooland constantly squirms in his seat
-Sometimes gets up in the middle of class and roams around the room to look at different things
Mother’s Chief Complaints-His first grade teacher says he can’t sit still at schooland constantly squirms in his seat
-Sometimes gets up in the middle of class and roams around the room to look at different things
-Becomes problematic when he has to waitfor things that he wants
Mother’s Chief Complaints-His first grade teacher says he can’t sit still at schooland constantly squirms in his seat
-Sometimes gets up in the middle of class and roams around the room to look at different things
-Becomes problematic when he has to waitfor things that he wants
-Always grabs things away from other children
Mother’s Chief Complaints-His first grade teacher says he can’t sit still at schooland constantly squirms in his seat
-Sometimes gets up in the middle of class and roams around the room to look at different things
-Becomes problematic when he has to waitfor things that he wants
-Always grabs things away from other children
-Interrupts when others are speaking
Mother’s Chief Complaints-His first grade teacher says he can’t sit still at schooland constantly squirms in his seat
-Sometimes gets up in the middle of class and roams around the room to look at different things
-Becomes problematic when he has to waitfor things that he wants
-Always grabs things away from other children
-Interrupts when others are speaking
-Doesn’t wait for teacher to finish asking a question before beginning to answer
History of Present Illness
-6-year-old boy
-Mom says he’s shown hyperactive/inattentive behaviors for almost one year
-“Everything seems to be getting worse”
-Teachers complain that he doesn’t listen or follow instructions like other kids, gets easily bored during activities
-Has difficulty waiting his turn
-Can’t engage in playground games for any significant length of time
-Behavior has been so disruptive that no daycare centers will accept him
-Mom is a single parent and must work to support son and herself
Past Medical HistorySon was taken to pediatrician 4 months ago
for similar symptoms; Mother’s complaints were dismissed
Pregnancy and delivery were normalVaccinations up to dateNo prior surgeries, serious medical
problems, or established psychiatric illnesses
Family HistoryFather left the family before the boy was
bornBoth maternal grandfather and maternal
uncle have history of hyperactivity as children
Mother denies drug, tobacco, and alcohol abuse during pregnancy
Family HistoryFather left the family before the boy was
bornBoth maternal grandfather and maternal
uncle have history of hyperactivity as children
Mother denies drug, tobacco, and alcohol abuse during pregnancy
Miscellaneous Information
Occasional GI upset and colds
Review of Systems
Miscellaneous Information
Occasional GI upset and colds
Review of Systems
Medications
None
Miscellaneous Information
Occasional GI upset and colds
Review of Systems
Medications
None
Allergies
No Known Drug Allergies
Limited Physical Examination and Lab Tests
Hearing Vision Skin
Within Normal Limits
Within Normal Limits
Warm and dry with no discoloration
Limited Physical Examination and Lab Tests
Hearing Vision Skin
Within Normal Limits
Within Normal Limits
Warm and dry with no discoloration
Head, Ears, Eyes, Nose, Throat
Neck/Lymph Nodes
Heart
PERRLA
Tympanic Membranes intact
Nose clear
Throat without erythema
Mucous Membranes normal
Neck supple without obvious nodal enlargement or thyromegaly
Regular Rate and Rhythm with no murmurs, rubs, or gallops
Limited Physical Examination and Lab Tests
Hearing Vision Skin
Within Normal Limits
Within Normal Limits
Warm and dry with no discoloration
Head, Ears, Eyes, Nose, Throat
Neck/Lymph Nodes
Heart
PERRLA
Tympanic Membranes intact
Nose clear
Throat without erythema
Mucous Membranes normal
Neck supple without obvious nodal enlargement or thyromegaly
Regular Rate and Rhythm with no murmurs, rubs, or gallops
Limited Physical Examination and Lab Tests
Lungs Genitalia Abdomen
Clear, normal breath sounds
Normal external male genitalia with circumcised penis
Soft and non-tender with normal bowel sounds and no palpable viscera or masses
Limited Physical Examination and Lab Tests
Lungs Genitalia Abdomen
Clear, normal breath sounds
Normal external male genitalia with circumcised penis
Soft and non-tender with normal bowel sounds and no palpable viscera or masses
Musculoskeletal/Extremities
Neurological
No Cyanosis, Clubbing, or Edema
Range of motion intact
Good peripheral pulses bilaterally
Alert and Oriented
Cranial Nerves II-XII intact
Deep Tendon Reflexes 3+ throughout
Sensory and motor function intact and gait normal
Limited Physical Examination and Lab Tests
Lungs Genitalia Abdomen
Clear, normal breath sounds
Normal external male genitalia with circumcised penis
Soft and non-tender with normal bowel sounds and no palpable viscera or masses
Musculoskeletal/Extremities
Neurological
No Cyanosis, Clubbing, or Edema
Range of motion intact
Good peripheral pulses bilaterally
Alert and Oriented
Cranial Nerves II-XII intact
Deep Tendon Reflexes 3+ throughout
Sensory and motor function intact and gait normal
General AppearancePatient is healthy-appearing and well-nourished
General AppearancePatient is healthy-appearing and well-nourished
He moves constantly, fidgeting with bothhis hands and feet
General AppearancePatient is healthy-appearing and well-nourished
He moves constantly, fidgeting with bothhis hands and feet
Gets easily distracted by minor noises
General AppearancePatient is healthy-appearing and well-nourished
He moves constantly, fidgeting with bothhis hands and feet
Gets easily distracted by minor noises
Repeatedly interruptshis mother and the pediatrician
Case Question 1Are any of the boy’s vital signs a major
cause for concern?
Case Question 1Are any of the boy’s vital signs a major
cause for concern?
BP 112/70
RR 15
HT 3’9
P 65
T 98.2 F
WT 50 lbs
Case Question 1Are any of the boy’s vital signs a major
cause for concern?
BP 112/70
RR 15
HT 3’9
P 65
T 98.2 F
WT 50 lbs
Age Heart Rate (beats/min) Blood Pressure (mm Hg)Respiratory Rate
(breaths/min)
3-6 yr 65-110 95-110/60-75 20-25
6-12 yr 60-95 100-120/60/75 14/22
12 > yr 55-85 110-135/65/85 12-18
Case Question 1Are any of the boy’s vital signs a major
cause for concern?
BP 112/70
RR 15
HT 3’9
P 65
T 98.2 F
WT 50 lbs
Age Heart Rate (beats/min) Blood Pressure (mm Hg)Respiratory Rate
(breaths/min)
3-6 yr 65-110 95-110/60-75 20-25
6-12 yr 60-95 100-120/60/75 14-22
12 > yr 55-85 110-135/65/85 12-18
Case Question 1Are any of the boy’s vital signs a major
cause for concern?
BP 112/70
RR 15
HT 3’9
P 65
T 98.2 F
WT 50 lbs
Age Heart Rate (beats/min) Blood Pressure (mm Hg)Respiratory Rate
(breaths/min)
3-6 yr 65-110 95-110/60-75 20-25
6-12 yr 60-95 100-120/60/75 14-22
12 > yr 55-85 110-135/65/85 12-18
Case Question 1Are any of the boy’s vital signs a major
cause for concern?
BP 112/70
RR 15
HT 3’9
P 65
T 98.2 F
WT 50 lbs
Age Heart Rate (beats/min) Blood Pressure (mm Hg)Respiratory Rate
(breaths/min)
3-6 yr 65-110 95-110/60-75 20-25
6-12 yr 60-95 100-120/60/75 14-22
12 > yr 55-85 110-135/65/85 12-18
Case Question 2What is the patient’s single most critical
risk factor that is consistent with ADHD?
Case Question 2What is the patient’s single most critical
risk factor that is consistent with ADHD?
Case Question 2What is the patient’s single most critical
risk factor that is consistent with ADHD?
Additional Risk FactorsExposure to:
-Polychlorinated Biphenyls (PCBs)
-Lead
Case Question 3Can hyperthyroid disease be ruled out as a
cause of hyperactivity in this child?
Case Question 3Can hyperthyroid disease be ruled out as a
cause of hyperactivity in this child?
Hb 15.1 g/dL
Plt 290,000/mm3
TSH 3.8 µU/mL
Ht 43%
BUN 11 mg/dL
T4’ total 6.8 µg/dL
WBC 7,253/mm3
Cr 0.7 mg/dL
Glu, fasting 75 mg/dL
Case Question 3Can hyperthyroid disease be ruled out as a
cause of hyperactivity in this child?
Hb 15.1 g/dL
Plt 290,000/mm3
TSH 3.8 µU/mL
Ht 43%
BUN 11 mg/dL
T4’ total 6.8 µg/dL
WBC 7,253/mm3
Cr 0.7 mg/dL
Glu, fasting 75 mg/dL
Case Question 3Can hyperthyroid disease be ruled out as a
cause of hyperactivity in this child?
Hb 15.1 g/dL
Plt 290,000/mm3
TSH 3.8 µU/mL
Ht 43%
BUN 11 mg/dL
T4’ total 6.8 µg/dL
WBC 7,253/mm3
Cr 0.7 mg/dL
Glu, fasting 75 mg/dL
Hb 11.5 -15.5 g/dL
Plt 150,000 – 450,000/mm3
TSH 0.32 – 5.0 µU/mL
Ht 34 – 40%
BUN 5-20 mg/dL
T4’ total 6.4 – 13.3 µg/dL
WBC 5 – 14.5/mm3
Cr 0.3-0.7 mg/dL
Glu, fasting 70 – 110 mg/dL
Case Question 3Can hyperthyroid disease be ruled out as a
cause of hyperactivity in this child?
Hb 15.1 g/dL
Plt 290,000/mm3
TSH 3.8 µU/mL
Ht 43%
BUN 11 mg/dL
T4’ total 6.8 µg/dL
WBC 7,253/mm3
Cr 0.7 mg/dL
Glu, fasting 75 mg/dL
Hb 11.5 -15.5 g/dL
Plt 150,000 – 450,000/mm3
TSH 0.32 – 5.0 µU/mL
Ht 34 – 40%
BUN 5-20 mg/dL
T4’ total 6.4 – 13.3 µg/dL
WBC 5 – 14.5/mm3
Cr 0.3-0.7 mg/dL
Glu, fasting 70 – 110 mg/dL
Case Question 3Can hyperthyroid disease be ruled out as a
cause of hyperactivity in this child?
Hb 15.1 g/dL
Plt 290,000/mm3
TSH 3.8 µU/mL
Ht 43%
BUN 11 mg/dL
T4’ total 6.8 µg/dL
WBC 7,253/mm3
Cr 0.7 mg/dL
Glu, fasting 75 mg/dL
Hb 11.5 -15.5 g/dL
Plt 150,000 – 450,000/mm3
TSH 0.32 – 5.0 µU/mL
Ht 34 – 40%
BUN 5-20 mg/dL
T4’ total 6.4 – 13.3 µg/dL
WBC 5 – 14.5/mm3
Cr 0.3-0.7 mg/dL
Glu, fasting 70 – 110 mg/dL
Case Question 3Can hyperthyroid disease be ruled out as a
cause of hyperactivity in this child?
Hb 15.1 g/dL
Plt 290,000/mm3
TSH 3.8 µU/mL
Ht 43%
BUN 11 mg/dL
T4’ total 6.8 µg/dL
WBC 7,253/mm3
Cr 0.7 mg/dL
Glu, fasting 75 mg/dLNote that the physical examination
showed no obvious nodal enlargement or thyromegaly.
Case Question 4Is this patient’s CBC normal or abnormal?
Hb 15.1 g/dL
Plt 290,000/mm3
TSH 3.8 µU/mL
Ht 43%
BUN 11 mg/dL
T4’ total 6.8 µg/dL
WBC 7,253/mm3
Cr 0.7 mg/dL
Glu, fasting 75 mg/dL
Hb 11.5 -15.5 g/dL
Plt 150,000 – 450,000/mm3
TSH 0.32 – 5.0 µU/mL
Ht 35 – 46%
BUN 5-20 mg/dL
T4’ total 6.4 – 13.3 µg/dL
WBC 5k – 14.5k/mm3
Cr 0.3-0.7 mg/dL
Glu, fasting 70 – 110 mg/dL
Case Question 4Is this patient’s CBC normal or abnormal?
Hb 15.1 g/dL
Plt 290,000/mm3
TSH 3.8 µU/mL
Ht 43%
BUN 11 mg/dL
T4’ total 6.8 µg/dL
WBC 7,253/mm3
Cr 0.7 mg/dL
Glu, fasting 75 mg/dL
Hb 11.5 -15.5 g/dL
Plt 150,000 – 450,000/mm3
TSH 0.32 – 5.0 µU/mL
Ht 35 – 46%
BUN 5-20 mg/dL
T4’ total 6.4 – 13.3 µg/dL
WBC 5k – 14.5k/mm3
Cr 0.3-0.7 mg/dL
Glu, fasting 70 – 110 mg/dL
Case Question 4Is this patient’s CBC normal or abnormal?
Hb 15.1 g/dL
Plt 290,000/mm3
TSH 3.8 µU/mL
Ht 43%
BUN 11 mg/dL
T4’ total 6.8 µg/dL
WBC 7,253/mm3
Cr 0.7 mg/dL
Glu, fasting 75 mg/dL
Hb 11.5 -15.5 g/dL
Plt 150,000 – 450,000/mm3
TSH 0.32 – 5.0 µU/mL
Ht 35 – 46%
BUN 5-20 mg/dL
T4’ total 6.4 – 13.3 µg/dL
WBC 5k – 14.5k/mm3
Cr 0.3-0.7 mg/dL
Glu, fasting 70 – 110 mg/dL
Case Question 4Is this patient’s CBC normal or abnormal?
Hb 15.1 g/dL
Plt 290,000/mm3
TSH 3.8 µU/mL
Ht 43%
BUN 11 mg/dL
T4’ total 6.8 µg/dL
WBC 7,253/mm3
Cr 0.7 mg/dL
Glu, fasting 75 mg/dL
Hb 11.5 -15.5 g/dL
Plt 150,000 – 450,000/mm3
TSH 0.32 – 5.0 µU/mL
Ht 35 – 46%
BUN 5-20 mg/dL
T4’ total 6.4 – 13.3 µg/dL
WBC 5k – 14.5k/mm3
Cr 0.3-0.7 mg/dL
Glu, fasting 70 – 110 mg/dL
Case Question 4Is this patient’s CBC normal or abnormal?
Hb 15.1 g/dL
Plt 290,000/mm3
TSH 3.8 µU/mL
Ht 43%
BUN 11 mg/dL
T4’ total 6.8 µg/dL
WBC 7,253/mm3
Cr 0.7 mg/dL
Glu, fasting 75 mg/dL
Hb 11.5 -15.5 g/dL
Plt 150,000 – 450,000/mm3
TSH 0.32 – 5.0 µU/mL
Ht 35 – 46%
BUN 5-20 mg/dL
T4’ total 6.4 – 13.3 µg/dL
WBC 5k – 14.5k/mm3
Cr 0.3-0.7 mg/dL
Glu, fasting 70 – 110 mg/dL
Case Question 4Is this patient’s CBC normal or abnormal?
Hb 15.1 g/dL
Plt 290,000/mm3
TSH 3.8 µU/mL
Ht 43%
BUN 11 mg/dL
T4’ total 6.8 µg/dL
WBC 7,253/mm3
Cr 0.7 mg/dL
Glu, fasting 75 mg/dL
Hb 11.5 -15.5 g/dL
Plt 150,000 – 450,000/mm3
TSH 0.32 – 5.0 µU/mL
Ht 35 – 46%
BUN 5-20 mg/dL
T4’ total 6.4 – 13.3 µg/dL
WBC 5k – 14.5k/mm3
Cr 0.3-0.7 mg/dL
Glu, fasting 70 – 110 mg/dL
Case Question 5What is the significance of this patient’s
BUN and Cr concentrations?
Hb 15.1 g/dL
Plt 290,000/mm3
TSH 3.8 µU/mL
Ht 43%
BUN 11 mg/dL
T4’ total 6.8 µg/dL
WBC 7,253/mm3
Cr 0.7 mg/dL
Glu, fasting 75 mg/dL
Hb 11.5 -15.5 g/dL
Plt 150,000 – 450,000/mm3
TSH 0.32 – 5.0 µU/mL
Ht 35 – 46%
BUN 5-20 mg/dL
T4’ total 6.4 – 13.3 µg/dL
WBC 5k – 14.5k/mm3
Cr 0.3-0.7 mg/dL
Glu, fasting 70 – 110 mg/dL
Case Question 5What is the significance of this patient’s
BUN and Cr concentrations?
Hb 15.1 g/dL
Plt 290,000/mm3
TSH 3.8 µU/mL
Ht 43%
BUN 11 mg/dL
T4’ total 6.8 µg/dL
WBC 7,253/mm3
Cr 0.7 mg/dL
Glu, fasting 75 mg/dL
Hb 11.5 -15.5 g/dL
Plt 150,000 – 450,000/mm3
TSH 0.32 – 5.0 µU/mL
Ht 35 – 46%
BUN 5-20 mg/dL
T4’ total 6.4 – 13.3 µg/dL
WBC 5k – 14.5k/mm3
Cr 0.3-0.7 mg/dL
Glu, fasting 70 – 110 mg/dL
Case Question 5What is the significance of this patient’s
BUN and Cr concentrations?
Hb 15.1 g/dL
Plt 290,000/mm3
TSH 3.8 µU/mL
Ht 43%
BUN 11 mg/dL
T4’ total 6.8 µg/dL
WBC 7,253/mm3
Cr 0.7 mg/dL
Glu, fasting 75 mg/dL-Within normal ranges
- Rules out the presence of kidney disease or malnutrition
Case Question 6Does this patient satisfy all of the criteria
that are required for a diagnosis of ADHD?
Case Question 6Does this patient satisfy all of the criteria
that are required for a diagnosis of ADHD? 1. Either criteria for inattention or criteria for
hyperactivity/impulsivity must be met2. Onset occurs no later than 7 years of age3. Symptoms must be present in two or more
settings 4. Behavior causes clinically significant distress
or impairment in social, academic, or occupational settings
5. Symptoms do not occur during the course of schizophrenia or another psychotic disorder
Criteria for InattentionFails to be closely attentive to details, makes careless
mistakes in schoolwork or other activitiesHas difficulty sustaining attention during tasks or
while at playDoes not seem to listen when spoken to directlyDoes not follow through with instructions and fails to
finish schoolwork, chores, or dutiesHas difficulty organizing tasks and activitiesAvoids/strongly dislikes tasks that require sustained
mental effortLoses items necessary to complete tasks or activitiesIs easily distracted by extraneous stimuliIs forgetful in daily activities
Criteria for Inattention
Criteria for Inattention
Criteria for Inattention
Criteria for Inattention
Criteria for Inattention
Criteria for Inattention
Criteria for Inattention
Criteria for Inattention
Criteria for Inattention
Criteria for Hyperactivity/Impulsivity
Fidgets with hands or feet or squirms in seatLeaves seat in classroom or in other situations in
which remaining seated is expectedRuns around or climbs excessively in situations in
which this behavior is inappropriateHas difficulty playing quietly or engaging in leisure
activitiesOften “on the go” or acts as if “driven by a motor” Talks excessivelyBlurts out answers to questions before questions
have been completedHas difficulty waiting turnsInterrupts or intrudes on others
Criteria for Hyperactivity/Impulsivity
Fidgets with hands or feet or squirms in seatLeaves seat in classroom or in other situations in
which remaining seated is expectedRuns around or climbs excessively in situations in
which this behavior is inappropriateHas difficulty playing quietly or engaging in leisure
activitiesOften “on the go” or acts as if “driven by a motor” Talks excessivelyBlurts out answers to questions before questions
have been completedHas difficulty waiting turnsInterrupts or intrudes on others
Criteria for Hyperactivity/Impulsivity
Fidgets with hands or feet or squirms in seatLeaves seat in classroom or in other situations in
which remaining seated is expectedRuns around or climbs excessively in situations in
which this behavior is inappropriateHas difficulty playing quietly or engaging in leisure
activitiesOften “on the go” or acts as if “driven by a motor” Talks excessivelyBlurts out answers to questions before questions
have been completedHas difficulty waiting turnsInterrupts or intrudes on others
Criteria for Hyperactivity/Impulsivity
Fidgets with hands or feet or squirms in seatLeaves seat in classroom or in other situations in
which remaining seated is expectedRuns around or climbs excessively in situations in
which this behavior is inappropriateHas difficulty playing quietly or engaging in leisure
activitiesOften “on the go” or acts as if “driven by a motor” Talks excessivelyBlurts out answers to questions before questions
have been completedHas difficulty waiting turnsInterrupts or intrudes on others
Criteria for Hyperactivity/Impulsivity
Fidgets with hands or feet or squirms in seatLeaves seat in classroom or in other situations in
which remaining seated is expectedRuns around or climbs excessively in situations in
which this behavior is inappropriateHas difficulty playing quietly or engaging in leisure
activitiesOften “on the go” or acts as if “driven by a motor” Talks excessivelyBlurts out answers to questions before questions
have been completedHas difficulty waiting turnsInterrupts or intrudes on others
Criteria for Hyperactivity/Impulsivity
Fidgets with hands or feet or squirms in seatLeaves seat in classroom or in other situations in
which remaining seated is expectedRuns around or climbs excessively in situations in
which this behavior is inappropriateHas difficulty playing quietly or engaging in leisure
activitiesOften “on the go” or acts as if “driven by a motor” Talks excessivelyBlurts out answers to questions before questions
have been completedHas difficulty waiting turnsInterrupts or intrudes on others
Criteria for Hyperactivity/Impulsivity
Criteria for Hyperactivity/Impulsivity
Criteria for Hyperactivity/Impulsivity
Criteria for Hyperactivity/Impulsivity
Case Question 6Does this patient satisfy all of the criteria
that are required for a diagnosis of ADHD? 1. Either criteria for inattention or criteria for
hyperactivity/impulsivity must be met 2. Onset occurs no later than 7 years of age 3. Symptoms must be present in two or more
settings 4. Behavior causes clinically significant distress
or impairment in social, academic, or occupational settings
5. Symptoms do not occur during the course of schizophrenia or another psychotic disorder
Case Question 6Does this patient satisfy all of the criteria
that are required for a diagnosis of ADHD? 1. Either criteria for inattention or criteria for
hyperactivity/impulsivity must be met √2. Onset occurs no later than 7 years of age 3. Symptoms must be present in two or more
settings 4. Behavior causes clinically significant distress
or impairment in social, academic, or occupational settings
5. Symptoms do not occur during the course of schizophrenia or another psychotic disorder
Case Question 6Does this patient satisfy all of the criteria
that are required for a diagnosis of ADHD? 1. Either criteria for inattention or criteria for
hyperactivity/impulsivity must be met √2. Onset occurs no later than 7 years of age √3. Symptoms must be present in two or more
settings 4. Behavior causes clinically significant distress
or impairment in social, academic, or occupational settings
5. Symptoms do not occur during the course of schizophrenia or another psychotic disorder
Case Question 6Does this patient satisfy all of the criteria
that are required for a diagnosis of ADHD? 1. Either criteria for inattention or criteria for
hyperactivity/impulsivity must be met √2. Onset occurs no later than 7 years of age √3. Symptoms must be present in two or more
settings √4. Behavior causes clinically significant distress
or impairment in social, academic, or occupational settings
5. Symptoms do not occur during the course of schizophrenia or another psychotic disorder
Case Question 6Does this patient satisfy all of the criteria
that are required for a diagnosis of ADHD? 1. Either criteria for inattention or criteria for
hyperactivity/impulsivity must be met √2. Onset occurs no later than 7 years of age √3. Symptoms must be present in two or more
settings √4. Behavior causes clinically significant distress
or impairment in social, academic, or occupational settings √
5. Symptoms do not occur during the course of schizophrenia or another psychotic disorder
Case Question 6Does this patient satisfy all of the criteria
that are required for a diagnosis of ADHD? 1. Either criteria for inattention or criteria for
hyperactivity/impulsivity must be met √2. Onset occurs no later than 7 years of age √3. Symptoms must be present in two or more
settings √4. Behavior causes clinically significant distress
or impairment in social, academic, or occupational settings √
5. Symptoms do not occur during the course of schizophrenia or another psychotic disorder √
Case Question 6Does this patient satisfy all of the criteria
that are required for a diagnosis of ADHD? 1. Either criteria for inattention or criteria for
hyperactivity/impulsivity must be met √2. Onset occurs no later than 7 years of age √3. Symptoms must be present in two or more
settings √4. Behavior causes clinically significant distress
or impairment in social, academic, or occupational settings √
5. Symptoms do not occur during the course of schizophrenia or another psychotic disorder √
Case Question 7Is this patient predominantly hyperactive,
predominantly inattentive, does he show signs of combined inattention and hyperactivity, or are the minimal diagnostic criteria for ADHD lacking?
Case Question 7Is this patient predominantly hyperactive,
predominantly inattentive, does he show signs of combined inattention and hyperactivity, or are the minimal diagnostic criteria for ADHD lacking?
Predominantly Hyperactive
Case Question 8Which of the following is the most
appropriate therapy for this patient? Ritalin hydrochloride, 5 mg before breakfast
and lunchRitalin hydrochloride, 20 mg before each
mealCylert 37.5 mg as a single dose every
morning Adderall, 5 mg once daily + psychotherapyTofranil, 25 mg twice daily + psychotherapy
Case Question 8Which of the following is the most
appropriate therapy for this patient? Ritalin hydrochloride
Prescribed for a stabilizing effect in children with ADHD
Should be initiated in small doses, starting with 5mg twice a day
Case Question 8Which of the following is the most
appropriate therapy for this patient?
Cylert 37.5 mg as a single dose every morning
Case Question 8Which of the following is the most
appropriate therapy for this patient? Cylert
Specifically indicated for treatment of ADHD
Case Question 8Which of the following is the most
appropriate therapy for this patient? Cylert
Specifically indicated for treatment of ADHD
CAUTION: Associated with life-threatening hepatic failure
Case Question 8Which of the following is the most
appropriate therapy for this patient?
Adderall, 5 mg once daily + psychotherapy
Case Question 8Which of the following is the most
appropriate therapy for this patient? Adderall
Specifically indicated for treatment of ADHD and Narcolepsy
Case Question 8Which of the following is the most
appropriate therapy for this patient?
Tofranil, 25 mg twice daily + psychotherapy
Case Question 8Which of the following is the most
appropriate therapy for this patient? Tofranil
Used to treat depression
Case Question 8Which of the following is the most
appropriate therapy for this patient? Ritalin hydrochloride, 5 mg before breakfast
and lunchRitalin hydrochloride, 20 mg before each
mealCylert 37.5 mg as a single dose every
morning Adderall, 5 mg once daily + psychotherapyTofranil, 25 mg twice daily + psychotherapy
Case Question 8Ritalin Adderall
Effects Increases amount of dopamine and norepinephrine between synapses in the brain.
Increases amount of dopamine and norepinephrine between synapses in the brain.
Potential Side Effects Nervousness, drowsiness, insomnia. Can cause psychosis with long-term use
Weight loss, insomnia, headaches, irritability, increased muscle tension, anxiety, increased heart rate, increased blood pressure, dry mouth, reduced efficacy over time.
Dependence Liability Lower compared to Adderall
High
Case Question 8
Case Question 8