Children and Adults with Attention

Children and Adults with Attention Deficit Disorders, 499 N.W. 70th Ave., Suite 101, Planation, FL, USA, 33317, (800) 233-4050, . 

Not everyone agrees. For instance, the organization Children and Adults with Attention Deficit Disorder (CHADD) strongly argues for Ritalin use as a way to improve performance,... 

Children and Adults with Attention Deficit Disorder (CHADD)... 

Founded in 1987, Children and Adults with Attention Deficit Disorders (CHADD) has now expanded its horizons to include adults, as well, with... 

At the time of the first edition of this book in 1983, the organization called itself CH.A.D.D. That has been simplified to CHADD. Its official name has been expanded into Children and Adults with Attention Deficit Hyperactivity Disorders. 

It is important to carefully document core ADHD symptoms at baseline to provide a reference point from which to evaluate effectiveness of treatment. Improvement in individualized patient outcomes are desired, such as (1) family and social relationships, (2) disruptive behavior, (3) completing required tasks, (4) self-motivation, (5) appearance, and (6) self-esteem. It is very important to elicit evaluations of the patient s behavior from family, school, and social environments in order to assess the preceding. Using standardized rating scales (e.g., Conners Rating Scales-Revised, Brown Attention-Deficit Disorder Scale, and IOWA Conners Scale) in both children and adults with ADHD helps to minimize variability in evaluation.29 After initiation of therapy, evaluations should be done every 2 to 4 weeks to determine efficacy of treatment, height, weight, pulse, and blood pressure. Physical examination or liver function tests may be used to monitor for adverse effects. 

The most successful treatments for ADHD have been those that increase the activity of the neurotransmitters dopamine and norepinephrine. It has been known for some time that our brains nse these two substances to focns attention during response to challenging or stressfnl situations. The theory that medications that increase the activity of either dopamine and/or norepinephrine would be good treatments for ADHD has largely proved true, and we now have medications that can help children and adults with ADHD tremendously. 

Dulcan, M. (American Academy of Child and Adolescent Psychiatry) (1997) Practice parameters for the assessment and treatment of children, adolescents and adults with attention-deficit/hyperactiv-ity disorder. / Am Acad Child Adolesc Psychiatry 36(Suppl) 85S-121S. 

More research has been done on pharmacotherapy of ADHD in children and adolescents with MR than for other disorders. Reviews by Aman (1996), Arnold et al. (1998), and Handen (1993) summarize the psychostimulant research (methylphenidate, amphetamine, and magnesium pemoline). Of the 10 or more group studies of methylphenidate or dextroamphetamine in children, adolescents, and adults with ADHD and MR/ DD since 1980, all but one were positive and statistically significant. They showed substantial benefit for motor overflow, attention span, and impulsiveness. Improvements were also seen in cognitive performance, some measures of social behavior, and independent play. The sole negative study was of adolescents and adults without ADHD, most of them with profound MR (see Aman, 1996). No studies of mixed amphetamine salts (Adderall) or magnesium pemoline (Cylert) were found for this population (Arnold et al., 1998). 

It has been suggested that abnormalities in attention-deficit/hyperactivity disorder in children and adults may be similar to those seen in early stages of PD (McCracken 1991). Of interest is that nicotinic mechanisms interact closely with dopamine systems (Kirch et al. 1988) and that nicotinic receptors may serve to regulate dopamine release (Clarke and Pert 1985 Rapier et al. 1990) in striatal and mesolimbic pathways. Nicotine is now being tried as an experimental treatment for attention-deficit/hyperactivity disorder in adults (Levin et al. 1995). 

According to the latest report of the American Diabetes Association in 2006, there are at least 20.8 million children and adults in the United States, or 7% of the population, who have diabetes. While an estimated 14.6 million have been diagnosed with diabetes, unfortunately, 6.2 million people (or nearly one-third) are unaware that they have the disease. That is why diabetes is also known as the silent killer. The rapid increase in the number of silent killers has caught the attention of the research world and recently almost double the number of scientists are working in this area compared to the last decade. 

Initially, the neuroleptics were used to manage severe anxiety, agitation, and aggression in individuals with severe mental illness such as schizophrenia, a psychotic illness characterized by delusions, hallucinations, and disorganized, illogical thinking. The first neuroleptic used in schizophrenia was chlorpromazine (Thorazine) in 1952. Additional neuroleptics were later developed to treat a variety of other disorders and conditions in children and adults, including autism, attention-deficit hyperactivity disorder (ADHD), bipolar dis-... 

As stated in Chapter 4, the number of children and adults diagnosed with ADHD in the United States has risen from 900,000 in 1990 to about 5 million in 2000.44 The reason for this steep increase is not clear. Some authors argue that there has been no actual increase in the number of cases, but a change in the environment, in the culture where children grow up. This change in the culture draws attention to symptoms (now called ADHD) that, in a more primitive society, would have gone undetected, because they would not have... 

Methylphenidate (Ritalin). Ritalin is a sympathomimetic agent with psychostimulant properties similar to S(+)-amphetamine. It is widely used to treat attention deficit hyperactivity disorder (ADHD) in children and adults. There has been increasing diversion and abuse of methylphenidate among children and adults for its stimulant and purported aphrodisiac properties. In overdose, the clinical effects of methylphenidate are similar to those of amphetamine. Relatively few cases of serious overdose have been reported. 

Dr. Lynn Crismon s work in developing the Texas Medication Algorithms for treatment of depression in children and adults and the treatment of attention-deficit hyperactivity disorder in children" "" laid the groundwork for psychiatric pharmacists to work with psychiatrists, psychologists, other health care professionals, and consumer groups to develop and implement national therapeutic guidelines. 

Appendices 122-1 and 122-2 show the recommended schedules for routine immunization of children and adults. Many states require children to be fuUy immunized prior to entering elementary school however, optimal protection is achieved by immunizing at the recommended ages, which requires special attention to children younger than 2 years of age. Adults and adolescents also require vaccination and often are unaware of this need. Adults should receive routine tetanus-diphtheria boosters and be immune to measles, mumps, rubella, and varicella by either immunization or history of infection. Certain individuals with conditions or lifestyles that put them at high risk for vaccine-preventable diseases also should be immunized as described in the text that follows and outlined in the immunization schedules in the appendices. 

Hiccup is a forceful, involuntary inspiration commonly experienced by fetuses, children, and adults. Its purpose is unknown, and its pathophysiology still poorly understood. Short hiccup bouts are mostly associated with gastric distention or alcohol intake. They resolve spontaneously or with simple folk remedies and do not require medical attention. In contrast, prolonged hiccup is a rare but disabling condition that can induce depression, weight loss, and sleep deprivation. A wide variety of pathological conditions can cause chronic hiccup myocardial infarction, brain tumor, renal failure, prostate cancer, and abdominal surgery are only a few of these conditions. 

OTHER THERAPEUTIC USES OE THESE DRUGS The various antidepressant agents have found broad utility in other disorders that may not be related psychobiologicaUy to the mood disorders. Current applications include rapid but temporary suppression of enuresis with low (e.g., 25 mg) pre-bedtime doses of tricyclic antidepressants, including imipramine and nortriptyline, by uncertain mechanisms in children and in geriatric patients, as well as a beneficial effect of duloxetine on urinary stress incontinence. Antidepressants have a growing role in attention-deficit/hyperactivity disorder in children and adults, for which imipramine, desipramine, and nortriptyline appear to be effective, even in patients responding poorly to or who are intolerant of the stimulants (e.g., methylphenidate). Newer NE selective reuptake inhibitors also may be useful in this disorder atomoxetine is approved for this application. Utility of SSRIs in this syndrome is not established, and bupropion, despite its similarity to stimulants, appears to have limited efficacy. 

Findling, R. (1996). Open-label treatment of comorbid depression and attentional disorder with co-administration of SRI s and psychostimulants in children, adolescents, and adults a case series. / Child Adolescent Psychopharmacol 6 165—175. 

These data suggest that there is more available information for use of lithium than for other mood stabilizers, and that adolescents hospitalized with adolescent-onset, acute mania have rates of response between 50% and 80%. Supplementation with sedating medication appears to be common but not systematically evaluated. Children hospitalized with mania also respond to lithium, but their comorbid disorders often need separate attention. Open trials with DVP in hospitalized adolescents are also supported. There is much less information on CBZ and there are no data on newer anticonvulsants such as lamotrigine, topiramate, or gabapentin. These data are largely consistent with data from studies of hospitalized adults with classic mania. 

---