Diagnosis in Children
–Vanderbilt ADHD Assessment Forms (Both teacher and parent forms).
–Coexisting or mimicking conditions, considered.
-Labs: CBC, CMP, TSH, 25 hydroxy Vit D level.
Treatment
-Preschool age ( < 6 years old, i.e 5 years and younger) – Behavioral therapy (BT) alone.
-School Age (≥ 6 years of age) – Start with medication. Add BT as an adjunct. BT is less effective in this age group.
–Pharmacotherapy options reviewed.
-Refer to psychiatry as needed.
-Fish oil with 2:1 EHA to DHA ratio or a combination. Brand name: Nature’s bounty sold at Costco.
-Monitoring: F/u monthly until appropriate med dosing and timing achieved. After that, will f/u q3mo for the first year and then 2-3 times/year after that.
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ADHD pearls and links
- ADD / ADHD in Adults.
- Adult ADHD Self-Report Scale.
- Stimulants are the most effective meds for ADHD and are 1st-line.
- Atomoxetine and guanfacine are considered 2nd-line because they are less effective and have more frequent s/e.
- Bupropion is not FDA approved but is used off-label for ADHD.
- A child psychiatrist I know gets vitamin D level in all her ADHD patients and her depression patients. Replacement helps with mood. New research doesn’t support that.
ADHD in Adults
- To diagnose attention-deficit disorder (ADD) in an adult, symptoms must interfere with social, academic, or occupational functioning and must be present in more than one setting.
- DSM-5 states that a history of symptoms before age 12 is required for the diagnosis.
- See AFP article below.
References & Resources
ADHD Medication Guide
Click to access adhd_med_guide_092416.pdf
Am Fam Physician. 2014 Oct 1;90(7):456-464. http://www.aafp.org/afp/2014/1001/p456.html
Am Fam Physician. 2012 May 1;85(9):890-896. Diagnosis and Management of Attention-Deficit/Hyperactivity Disorder in Adults. https://www.aafp.org/afp/2012/0501/p890.html