Adhd

[50960]

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As a medical psychologist working in primary care and peds, I am wondering what your thoughts are on ADHD?? No agenda, just looking for info on what ped docs think about this Dx.

PS. Thanx DeanWormer😀

 

[edmadison]

As a medical psychologist working in primary care and peds, I am wondering what your thoughts are on ADHD?? No agenda, just looking for info on what ped docs think about this Dx.

PS. Thanx DeanWormer😀

See it all the time. Typically get good history, consider alternate diagnoses (LD, hearing deficit, depression, anxiety). In almost all cases start with the Vanderbilt/NICHQ evaluation tool. If that shows positive will try trial of Concerta, usually 18mg. Nice thing about stimulants for ADHD, they work quickly: You can tell if they work in a few days. I also encourage structure at home and at school. Monitor for side effects. Real trouble tends to be insomnia and appetite supression. I'm pretty anti sleeping aid, but many will try clonidine or trazadone. You can usually modualte the dose with short and long acting medication to fix the insomnia. My biggest problem tends to be the appetite.

Ed

 

[malchik]

I'm no pediatrician, but I think it's BS. Well, that's a little harsh, more like overdiagnosed and overprescribed. I know a 7-year-old very well who was given this diagnosis, and I don't believe it for a second. She's struggling in school because of dyslexia, not hyperactivity. There's probably a continuum, and the threshold for diagnosis may be set too leniently. Who wouldn't benefit from a little psychopharmacological stimulation?

 

[edmadison]

I'm no pediatrician, but I think it's BS. Well, that's a little harsh, more like overdiagnosed and overprescribed. I know a 7-year-old very well who was given this diagnosis, and I don't believe it for a second. She's struggling in school because of dyslexia, not hyperactivity. There's probably a continuum, and the threshold for diagnosis may be set too leniently. Who wouldn't benefit from a little psychopharmacological stimulation?

Everything is overdiagnosed and overprescribed. How many patients get ABX for bronchitis, "sinus infections", sore throats.... Many physicians find it difficult to send patient's home without an intervention. ADHD is both under and overdiagnosed. I can assure you that many cases of ADHD are real. I've had several patient who have such bad ADHD that they can't play video games for more than 5 minutes. I've had others that have insomnia because their minds race when they attempt to sleep. They responded to stimulants. There are many many explinations for ADHD symtpoms. That's why a suspect child should see someone that's trained in the evaluation and treatment of ADHD. If you are not looking for the alternative diagnoses such as LD, vision/hearing deficit, depression, anxiety..., then your are comitting malpractice.

ed

 

[50960]

There is a high comorbidity with bipolar and ADHD; how do you address this in your practice as stimulants, especially methylphenidate varieties do not treat BPD and often can wake it worse.
It is well known that we all could function better with a little amphetamine qam, and the response to said meds is no longer a criteria to validate Dx; do you refer to mental health?, psych testing?

 

[Homunculus]

I'm no pediatrician, but I think it's BS. Well, that's a little harsh, more like overdiagnosed and overprescribed. I know a 7-year-old very well who was given this diagnosis, and I don't believe it for a second. She's struggling in school because of dyslexia, not hyperactivity. There's probably a continuum, and the threshold for diagnosis may be set too leniently. Who wouldn't benefit from a little psychopharmacological stimulation?

There is a high comorbidity with bipolar and ADHD; how do you address this in your practice as stimulants, especially methylphenidate varieties do not treat BPD and often can wake it worse.
It is well known that we all could function better with a little amphetamine qam, and the response to said meds is no longer a criteria to validate Dx; do you refer to mental health?, psych testing?

ed pretty much covered it. ADHD is a spectrum disorder-- very little is cut and dried in the developmental arena (look at autism, lol). if there were only an ADHD titer we could go byl. yeah, there are variations of normal, and unfortunately it has been my experience that the parents, not the providers, are the ones pushing for medical interventions. toddlers and early schoolage kids are not little adults, and to expect that of them is unreasonable. i use vanderbilts like ed, and anyone who i even get a whiff of something strange will usually get a devo consult. even uncomplicated ADD or ADHD i first use environmental and cognitive strategies to see if that allows them to function more normally. i have the advantage of having referral resources available at no cost to my patients-- in the civilian world i imagine kids are much more likely to get started on meds.

personally, i think we need ADHDers around-- thik about it-- who was the person who decided that an artichoke would be good to eat? had to be someone with ADHD, lol.

--your friendly neighborhood non-medicated ADHD caveman

 

[oldbearprofessor]

as stimulants, especially methylphenidate varieties do not treat BPD and often can wake it worse.

Well, in my business we use a stimulant (caffeine) to treat apnea often seen in babies with BPD. I've never heard of it making the BPD worse, although it can increase reflux and that could potentially lead to microaspiration and worsening BPD.

Oh....never mind

i have no thoughts on the actual question asked.

 

[Homunculus]

Well, in my business we use a stimulant (caffeine) to treat apnea often seen in babies with BPD. I've never heard of it making the BPD worse, although it can increase reflux and that could potentially lead to microaspiration and worsening BPD.

Oh....never mind

i have no thoughts on the actual question asked.

the NICU and all of its abbreviations is borderline insane. RDS, CHD (VSD/ASD, TOF, TGA), PDA, PTX, SGA, AGA, BPD, ROP, IVH, NEC, UVC/UAC, ETT, GBS, MAS, TTN, PPHN, ECMO, PEEP, PIP, SBI, CCAM, CDH, CBG/ABG, TPN, UOP, CKD (MKD), CKH (MKH), NG/OG, . . . total PITA 😀

yeah i know-- a lot of those are elsewhere in peds, too. but they all come together in the wonderful world of NICU. 🙂

--your friendly neighborhood successful NICU rotator x4 caveman

 

[50960]

By BPD, I meant bipolar disorder, sorry.

s

 

[Homunculus]

By BPD, I meant bipolar disorder, sorry.

s

OBP knew that i think. was part of the joke 😉

--your friendly neighborhood should add "OBP" to NICU abbreviation list caveman

 

[oldbearprofessor]

By BPD, I meant bipolar disorder, sorry.

s

Oh, in that case, I recommend sucrose-containing pacifiers and swaddling when medically feasible. Stops most of the crying, even when the IV is being started. And with that, I promise to retire from this thread.....

 

[Palmetto]

My problem is that now, in my mind's eye, I cannot separate OBP's avatar and the actual attending lurking behind it. I seriously have this image of a six foot tall plush Ohio State teddy walking around the NICU, peering into bassonettes and titrating PEEP.

I also have no comments on ADHD, except that I'm sure I would have been on medicine when I was in middle school, since I got mostly C's and enjoyed doodling. Which I suppose could be argued for college as well. Go 'Hoos.

How funny that an ADHD thread has gotten off subject.

 

[50960]

Exactly....lol.

 

[TexasRose]

My problem is that now, in my mind's eye, I cannot separate OBP's avatar and the actual attending lurking behind it. I seriously have this image of a six foot tall plush Ohio State teddy walking around the NICU, peering into bassonettes and titrating PEEP.

How funny that an ADHD thread has gotten off subject.

I've heard that description may not be that far from the truth...


The irony is not lost.





To the OP, as a med student going into peds, I can only tell you that there seems to be very little respect for the Dx of ADHD in the medical school arena. Add to that the confounding issue of people taking the drugs who do not have ADHD, just to improve their grades and you get a very complicated and volatile issue.
As a former teacher, I have a healthy respect for the problems that kids with ADHD face and feel that the dx and the medical therapy under the right circumstances can be a life saver. (not just quality of life, but also actual lives)

 

[oldbearprofessor]

My problem is that now, in my mind's eye, I cannot separate OBP's avatar and the actual attending lurking behind it. I seriously have this image of a six foot tall plush Ohio State teddy walking around the NICU, peering into bassonettes and titrating PEEP.

I've heard that description may not be that far from the truth...

What are you folks talking about???

1. I'm not 6 feet - I wish
2. We don't ventilate babies in bassonettes here!!

and yes, I lied about not posting anymore on this thread. But the OP didn't seem to mind and it is theme-consistent as noted.

Off to Glendale Monday for the game. Texas had its title last year, this time it's our turn! 😀

 

[fathertime1987]

See it all the time. Typically get good history, consider alternate diagnoses (LD, hearing deficit, depression, anxiety). In almost all cases start with the Vanderbilt/NICHQ evaluation tool. If that shows positive will try trial of Concerta, usually 18mg. Nice thing about stimulants for ADHD, they work quickly: You can tell if they work in a few days. I also encourage structure at home and at school. Monitor for side effects. Real trouble tends to be insomnia and appetite supression. I'm pretty anti sleeping aid, but many will try clonidine or trazadone. You can usually modualte the dose with short and long acting medication to fix the insomnia. My biggest problem tends to be the appetite.

Ed

Melatonin for sleep is much safer try that first very low dose because your body only needs 0.5mg

 

[referee3]

Melatonin for sleep is much safer try that first very low dose because your body only needs 0.5mg

5year old thread. Cool post bro.

 

[fathertime1987]

5year old thread. Cool post bro.

Hahahaa