26 Jan 2006 26 Jan 2006 Workshop on ADHD in Workshop on ADHD in Third Level students Third Level students Fiona McNicholas Consultant Lucena Clinic, Rathgar & Our Lady’s Hospital for Sick Children, Crumlin Professor Child & Adolescent Psychiatry, UCD Martin O’Sullivan Consultant Child and Adolescent Psychiatrist Mater Hospital and St Vincent’s Hospital Fairview
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26 Jan 2006 Workshop on ADHD in Third Level students Fiona McNicholas Consultant Lucena Clinic, Rathgar & Our Ladys Hospital for Sick Children, Crumlin.
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26 Jan 200626 Jan 2006
Workshop on ADHD in Third Workshop on ADHD in Third Level studentsLevel students
• Over activity • Inattention• Impulsivity • Symptoms before age 7
(6 ICD) • Pervasive across
situation • Cause impairment of
social or educational functioning.
• Not due to PDD, Psychotic or other mental disorder (anxiety, depression)
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Inattention: (6/9)Inattention: (6/9)
– Fails to give close attention to details or makes careless errors in schoolwork, or other activities
– Difficulty sustaining attention in tasks or play activities– Does not seem to listen when spoken to directly– Does not follow through on instructions and fails to finish school
work, chores or duties (not due to oppositional behaviour or failure to understand)
– Difficulty organising tasks/activities– Avoids, dislikes or reluctant to engage in tasks that require
sustained mental effort– Loses things necessary for tasks– Easily distracted by extraneous stimuli– Forgetful in daily activities
• Leaves seat in classroom or other in which sitting is expected
• Runs about, climbs excessively in situations in which it is inappropriate (restless)
• Difficulty playing in activities quietly• ‘On the go’ or ‘driven by a motor’• Talks excessively• Blurts out answers• Difficulty awaiting turn• Interrupts or intrudes on others
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Common Associated Common Associated ComorbiditiesComorbidities
(%)
Milberger et al. Am J Psychiatry 1995; 152: 1793–1799Biederman et al. J Am Acad Child Adolesc Psychiatry 1997; 36: 21–29Castellanos. Arch Gen Psychiatry 1999; 56: 337–338Goldman et al. JAMA 1998; 279: 1100–1107Szatmari et al. J Child Psychol Psychiatry 1989; 30: 219–230
60
40
20
0Oppositional
defiant disorder
Anxiety disorder
Learning disorder
Mood disorder
Conductdisorder
Substance use disorder
Tics
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PrevalencePrevalence
• ICD 1-2 % or DSM IV 3-5%
• 30-50% of children referred to child psychiatry clinics have ADHD
• Diagnosed in boys 3-4 often than in girls
• Persists in 30-50% of patients into adolescence and adulthood (symptom profile may change)
• Prevalence in Adults: 2%
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Associated problemsAssociated problems
• School:• Language impairment 15-
75%• Learning Disability 15-
40%• Low Self esteem• Poor social skills• Labelled
‘trouble maker’
• Poor relationship with parents – often secondary and
improves with appropriate intervention
• Family History ADHD
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ADHD more likely than norms toADHD more likely than norms to
• Drop out of school 32-40%
• Rarely complete college 5-10%
• Under-perform at work 70-80%
• Have few or no friends 50-70%
• Engage in antisocial activities 40-50%
• Experience teen pregnancy 40%
• Sexually transmitted disease 16%
• Speed or have car accidents
• Suffer from depression 20-30%
• Have a personality disorder 18-25%
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Assessment: History & ObservationsAssessment: History & Observations
• Symptoms of ADHD– Home– School– After school activities
• Co-morbidity– LD– Motor– ODD/CD– Other child psychiatric
Strattera• Approved by FDA for treatment of adults• Potent selective NA reuptake inhibitor• Not ‘controlled’• C/I MAOI users, glaucoma• Cautions: liver problems/ cardiovascular/
depression/ suicidality• Await trials in those with depression/ anxiety • Metabolised CYP2D6 enzyme Fluoxetine,