Attention Deficit Hyperactivity Disorder

_ A disorder of incompetence not non-compliance

_ A disorder of consistency

ADHD - components of the definition

_ Inattention and distractibility

_ Overarousal

_ Impulsivity

_ Difficulty with gratification

&endash; Rewards

&endash; Require immediate gratification

&endash; Long-term goals or rewards not effective

ADHD subtypes

1. Predominantly inattentive type (this type does not have motor hyperactivity but rather more impulsive behavior pattern

2. Predominantly hyperactive-impulsive type (this type has the stereotypical excessive motor actvitiy

3. Combined type

ADHD characteristics

For a diagnosis of ADHD, there must be a fulfillment of the following characteristics;

_ 6 or more of the symptoms

_ Persistent for at least 6 months

_ To a degree that is maladaptive and inconsistent with developmental level

_ Some symptoms present before age 7 years

_ Impairment is present in 2 or more settings

&endash; School, work, home

_ clear evidence of academic difficulties

Predominantly inattentive type symptoms

_ Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities

_ Often has difficulty sustaining attention in tasks or play activities

_ Often doess not seem to listen when spoken to directly

_ Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace

_ Often has difficulty organizing tasks and activities

_ Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g. school work, home work)

_ Often loses things necessary for tasks or activities

&endash; Toys

&endash; School assignments

&endash; Pencils, books

_ Is often easily distracted by extraneous stimuli

_ Is often forgetful in daily activities

Predominantly hyperactive-impulsive type symptoms

_ Often blurts out answers before questions have been completed

_ Often difficulty awaiting turn

_ Often interrupts or intrudes on others

_ Often fidgets with hands or feet or squirms in seat

_ Often leaves seat in classroom or in other situations in which remaining seated is expected

_ Often runs about or climbs excessively in situations in which it is inappropriate

_ Often has difficulty playing or engaging in leisure activities quietly

_ Is often "on the go" or acts if "driven by a motor"

_ Often talks excessively

ADHD Medications

_ Ritalin (methylphenidate)

&endash; dosage range from 5 mg/day - 60 mg/day

_ Ritalin-SR

&endash; 20 mg tablet (morning dose)

About Ritalin

• Production of Ritalin has increased more than 7x in the past 8 years
• 90% is consumed in the U.S.
• More teens try Ritalin by grinding it up and snorting it for $5/pill than get it by prescription
• One half million Rxs were written for pre-school children
• It is covered by MCOs

Ritalin side effects

_ Insomnia

_ Decreased appetite

_ Weight loss

_ Headache

_ Irritability

_ Stomach ache

_ Accommodative sufficiency

other ADHD Medications

_ Dexedrine (dextroamphetamine)

_ Cylert (Pemoline)

_ Side effects

&endash; Same as above

&endash; Cylert - abnormal liver function has been reported

Examination hints for optometrists:

• Be firm and consistent but not angry
• Provide a regular routine
• Remove distracters from pockets, exam room
• Don't give a series of directions; but one-at-a-time; make them short
• Rely on objective testing
• Use "This is important" or "This is new"
• Demand eye contact
• Repeatedly insist on attention to the task
• Move closer to the child
• If testing isn't going well, move onto something else, and then return
• Make good, quick observations and assessments
• Schedule appointment when you aren't busy or when there are few patients around
• Work alone