Drugs in ADHD (Attention Deficit Hyperactivity Disorder) Dr. Samir H Dalwai MD, DCH, FCPS, DNB, LLB Developmental & Behavioral Pediatrician, President, Indian Academy of Pediatrics-Mumbai, Chairperson, IAP Chapter of Developmental Pediatrics, Founder Director, New Horizons Group.
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Drugs in ADHD(Attention Deficit Hyperactivity Disorder)
Dr. Samir H DalwaiMD, DCH, FCPS, DNB, LLB
Developmental & Behavioral Pediatrician,President, Indian Academy of Pediatrics-Mumbai,
Chairperson, IAP Chapter of Developmental Pediatrics,Founder Director, New Horizons Group.
Politically correct means of
communication about kids with ADHD!
Politically correct means of
communication about kids with ADHD!
Jose S Perez’s interpretation of
how we wish it could be!
Opening Comments
1. ADHD is a syndrome with a constellation of symptoms
2. Core features are Hyperactivity, Impulsivity, Inattention….
and also INCONSISTANCY*.
3. Pervasive across many life functions, especially concerned with learning and achievement, classically called
“ executive functioning”
(*New Horizons Child Development Centre)
Opening Comments
4. Associated with many co-morbidities/co-exiting conditions
5. Requires multi-dimensional treatment approach which would include pharmacotherapy
6. Only a persistent and sustained goal oriented programme over a specified period of time with proper compliance along with adherence to medication is required for maximum benefit.
ADHD
Core features Core Features PLUS Co-morbidities= Clinical/Functional Features
Summary of prospective studies examining adherence to ADHD medications in children, adolescents and adults.
Summary of prospective studies examining adherence to ADHD medications in children, adolescents and adults.
Problems with ADHD drugs• SIDE EFFECTS• ABUSE• MISUSE•In a United States survey of middle-class adolescents and young adults, 11% surveyed reported that they sold their stimulant medication and 22% had misused it. •A Canadian survey of high school children from the Atlantic provinces revealed that 26% of adolescents report having diverted their ADHD medications one or more times
And hence.. Management should involve..
A • Behavioural intervention
B • Pharmacotherapy
C • Educational measures
D • Combination of above
ENSURE COMPLIANCE
Timely review of goals set
Individualised as per
strengths and challenges
Scientific
Goal specific (should
change with time as child
improves
The 6 step model of New Horizons Developmental Program
• 4. New Horizons Developmental Program (NHDP) with Time-bound Goals
Developmental Pediatrician
with Team and Parent
• 5. Individual Intervention Sessions across Departments,
• Documented and Monitored through daily logs, weekly reports and monthly review of Management Information System (MIS)
Team with Developmental Pediatrician with Centre Head, Clinical Coordinator
and Clinical Director
• 6. Reassessments and revised NHDP.
Developmental Pediatrician
with Team and Parent
MTA study results
New Horizons CDC data•Total no of children evaluated: 281
•Data available: 68
•Time frame of retrospective analysis :2015
•No. of children with ADHD: 13
•No. of children compliant to a 6 month programme: 13 (100%)
•No. of children compliant to a 1 year programme: 4 (30%)
Social factors
• India is home to 38 million children 0-9 years of age with one or more neurodevelopmental disorders (Silbeberg, 2014 and Census, 2011).
• Yet, only 2-3% of children with disabilities have access to education.
• Rehabilitation Council of India (RCI) estimated that 30 million children with disabilities need education. RCI aims to educate 10% of these children by 2020.
Key Messages
1. Consider ADHD to be a constellation of issues; the functional resolution of each of which is the ultimate aim of the physician.
2. The devil is in the detail; ensure each area has a target and a strategy.
3. Each strategy needs tactics; delivered via multiple stakeholders over a period of time.
4. This requires a Documented Program at the outset which will enumerate the script and the role of each player, lead the way till its conclusion; the New Horizons Developmental Program (NHDP) is one such indigenously developed program.
Thank You!
IAP Mumbai, IAP Navi Mumbai, IAP
CHAPTER OF DEVELOPMENTAL PEDIATRICS
National Conference of Developmental Pediatrics NCDP-EMBICON 2016Mumbai - 1, 2 October 2016
www.ncdp-embicon2016.comTheme: Integrating Developmental Pediatrics into Office Practice