General treatment guidelines about Attention Deficit Hyperactivity Disorder
1. General guidelines about ADHD
Attention-deficit/hyperactivity disorder (ADHD) is marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. People with ADHD experience an ongoing pattern of the following types of symptoms:
o Inattention means a person may have difficulty staying on task, sustaining focus, and staying organized, and these problems are not due to defiance or lack of comprehension.
o Hyperactivity means a person may seem to move about constantly, including in situations when it is not appropriate, or excessively fidgets, taps, or talks. In adults, hyperactivity may mean extreme restlessness or talking too much.
o Impulsivity means a person may act without thinking or have difficulty with self- control. Impulsivity could also include a desire for immediate rewards or the inability to delay gratification. An impulsive person may interrupt others or make important decisions without considering long-term consequences.
Inattention | Hyperactivity- Impulsivity |
Overlook or miss details and make seemingly careless mistakes in schoolwork, at work, or during other activities | Fidget and squirm while seated |
Have difficulty sustaining attention during play or tasks, such as conversations, lectures, or lengthy reading | Leave their seats in situations when staying seated is expected, such as in the classroom or the office |
Not seem to listen when spoken to directly | Run, dash around, or climb at inappropriate times or, in teens and adults, often feel restless |
Find it hard to follow through on instructions or finish schoolwork, chores, or duties in the workplace, or may start tasks but lose focus and get easily sidetracked | Be unable to play or engage in hobbies quietly |
Have difficulty organizing tasks and activities, doing tasks in sequence, keeping materials and belongings in order, managing time, and meeting deadlines | Be constantly in motion or on the go, or act as if driven by a motor |
Avoid tasks that require sustained mental effort, such as homework, or for teens and older adults, preparing reports, completing forms, or reviewing lengthy papers | Talk excessively |
Lose things necessary for tasks or activities, such as school supplies, pencils, books, tools, wallets, keys, paperwork, eyeglasses, and cell phone | Answer questions before they are fully asked, finish other people’s sentences, or speak without waiting for a turn in a conversation |
Be easily distracted by unrelated thoughts or stimuli. Be forgetful in daily activities, such as chores, errands, returning calls, and keeping appointments | Have difficulty waiting one’s turn Interrupt or intrude on others, for example in conversations, games, or activities |
History taking and examination including MSE Annexure 1 Special emphasis
· Medical history
2. a) Investigations required
a. Psychometric investigations: Vanderbilt ADHD Diagnostic Rating Scale
b. Laboratory: (if physical complications are present)
b) Comorbidity: In children autism spectrum disorder and in Adolescents Anxiety Disorder.
c) Differential Diagnosis: Anxiety Disorder, Bipolar Disorder, depression, Dysthymic disorder, Posttraumatic Stress Disorder, Sleep wake disorder.
3. Treatment
a) Psychopharmacology
· Methylp henidate
· Amphetamine
· Antidepressants
MANAGEMENT
Pharmacotherapy
The CNS stimulants. These drugs reduce hyperactivity and improve attention span. Dextroamphetamine and Methylphenidate are the drug of choice. They are to be given in the morning and at noon because nighttime dose may produce sleep difficulty.
Dextroamphetamine is given in a dose of 5-10 mg/day. Methylphenidate in doses of 0.25 - 1 mg/kg/day is effective. Non-stimulant: Atomoxetine (1-1.4 mg/kg qd)
Psychological Treatment
The parents and teachers are advised not to retaliate against the child but their hyperactivity could be channelized into outdoors sports and their poor attention can be improved by appropriate educational technology.
b) Psychosocial Intervention
a. If patient is in early stage
i) Psychoeducation: Nature of illness, etiology, progression, consequences, prognosis, treatment.
For patient | For caregiver/guardian |
At the time of consultation. | At the time of consultation |
ii) Parental counselling
iii) Hyperactivity could be channelized into outdoor sports and poor attention can be improved by appropriate educational technology
b. If patient is in mid or late stage
i) Cognitive Enhancement Therapy
ii) Cognitive Behaviour Therapy
4. Follow-up
a. Psychiatry OPD/ DMHP
· Initially once in two weeks for 2 months
· Monthly check up for 1 year.
b. Physical check-up at OPD
c. Through telephonic conversation/TeleManas 14416/18008914416
5. Referrals
a. Depending upon the severity and complications of the patient, he/she may need to be referred to Psychiatry department.
b. To TeleManas
c. To the nearest DMHP
d. To psychiatry OPD at Kulikawn Hospital an ZMC
e. To higher centers outside Mizoram through Referral Board.
References
No references available