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Attention Deficit Hyperactivity Disorder. Kevin Leehey M.D. 1980 E. Fort Lowell Rd. Suite 150 Tucson, AZ 85719 520-296-4280 fax 520-296-3835 http://leeheymd.com kevino@leeheymd.com. Attention Deficit Hyperactivity Disorder. ADHD Inattentive Type ADHD Hyperactive/Impulsive Type

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kevin leehey m d

Kevin Leehey M.D.

1980 E. Fort Lowell Rd. Suite 150

Tucson, AZ 85719

520-296-4280 fax 520-296-3835

http://leeheymd.com

kevino@leeheymd.com

attention deficit hyperactivity disorder1
Attention Deficit Hyperactivity Disorder
  • ADHD Inattentive Type
  • ADHD Hyperactive/Impulsive Type
  • ADHD Combined Type
  • ADHD NOS

Kevin Leehey, M.D.

296-3835

differential diagnosis
Differential Diagnosis
  • Medical or neurologic or other psychiatric conditions, such as hyperthyroidism, medication side-effects, anxiety disorders, post traumatic stress, depression, immature character, and oppositional behaviors, may look like ADHD but not actually be ADHD.

Kevin Leehey, M.D.

296-3835

co morbid
Co-morbid
  • Anxiety disorders, Tourette’s Syndrome, depression, post traumatic stress difficulties, behavioral problems, learning difficulties, coordination disorders, sensory integration disorders, PDD, etc.
  • The most common condition associated with ADHD is a learning disorder (about 50 percent)

Kevin Leehey, M.D.

296-3835

diagnostic criteria
Diagnostic Criteria

A.

  • Six (or more) of the symptoms of inattention have persisted for at least six-months to a degree that is maladaptive and inconsistent with developmental level
  • Or six (or more) of the symptoms of hyperactivity-impulsivity have persisted for at least six-months to a degree that is maladaptive and inconsistent with developmental level

Kevin Leehey, M.D.

296-3835

inattention
Inattention :
  • 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 does 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 (not due to oppositional behavior or failure to understand instructions)
  • Often has difficulty organizing tasks and activities
  • Often avoids, dislikes, or is reluctant to engage in tasks requiring sustained mental effort (such as schoolwork or homework)
  • Often loses things necessary for tasks or activities (ie: toys, school assignments, pencils, books, or tools)
  • Is often easily distracted by extraneous stimuli
  • Is often forgetful in daily activities

Kevin Leehey, M.D.

296-3835

hyperactivity impulsivity
Often fidgets with hands or feet and 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 (in adolescents or adults, may be limited to subjective feelings of restlessness)

Often has difficulty playing or engaging in leisure activities quietly

Is often “on the go” or often acts as if “driven by a motor

Often talks excessively

Often blurts out answers before questions have been completed

Often has difficulty awaiting his/her turn

Often interrupts or intrudes on others (eg: butts into conversations or games)

Hyperactivity: Impulsivity:

Kevin Leehey, M.D.

296-3835

more diagnostic criteria
More Diagnostic Criteria

B. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age seven years

C. Some impairment from the symptoms is present in two or more settings (ie: school, work, home)

D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning

E. The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and are not better accounted for by another mental disorder (ie: Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder)

making the diagnosis
Making the Diagnosis
  • ADHD is often diagnosed based on meeting at least the minimum criteria for ADHD from DSM-IV
  • Psychological testing, WISC-IV, Woodcock-Johnson-R
  • Rating scales such as the Connors or SNAP
  • Continuous Performance Task Tests
  • Observation of the child or adolescent’s behavior in school and non-school settings
  • Family history

Kevin Leehey, M.D.

296-3835

making the diagnosis1
Making the Diagnosis
  • Making the diagnosis for adults and preschoolers is more difficult. Many of the diagnostic criteria are described in terms most relevant for elementary, middle school, and less so, high school age groups. For adults, past history and data regarding school experiences and testing is often crucial (along with current and past functioning and family history).

Kevin Leehey, M.D.

296-3835

adhd trends
ADHD trends
  • 8 years old, third grade
  • Sixth grade, middle school
  • 3X Boys - wrong
  • Missed - girls, minorities, ODD, inattentive only, bright, co-morbid, mild
  • 5-7% of school age youth

Kevin Leehey, M.D.

296-3835

adhd is more difficult to diagnose in preschool
ADHD is more difficult to diagnose in preschool
  • A wider range of behavior is expectable
  • Attention span normally increases with age, as does impulse control and a lessening of physical hyperactivity
  • Parenting styles and cultural norms vary markedly in this age group
  • Medication treatment is often less helpful and less researched
  • Other interventions are often worthwhile
  • ADHD will become more clear with time

Kevin Leehey, M.D.

296-3835

executive function disorder
Executive Function Disorder
  • Disorganization and poor time management skills
  • Follow-through and carrying out plans
  • Getting schoolwork/homework done or turned in
  • Failure to complete or turn in assignments
  • Do (fully or partially) their assignments but fail to turn them in or lose them

Kevin Leehey, M.D.

296-3835

adhd diagnosis myths
ADHD diagnosis myths
  • Video/computer games, television, movies
  • “He/she can if he/she wants to”
  • “He/she is fine at home”, or 1:1, or at the office
  • “Lazy”, underachiever, unmotivated

Kevin Leehey, M.D.

296-3835

prognosis outcome
Prognosis, Outcome
  • ADHD can be mild, moderate, or severe
  • Learning disorders may also be mild, moderate, or severe
  • Associated conditions complicate
  • Ability of that youngster’s family, school, and even that youngster’s ability to adjust to his/her current developmental needs and to what is expected of him/her

Kevin Leehey, M.D.

296-3835

adhd prognosis
ADHD prognosis
  • Hyperactivity resolves for 50% around puberty; 75% by age 21
  • Inattention often persists
  • “School of hard knocks”
  • 25% have conduct disorders and or substance abuse
  • Higher risks MVA, job losses, relationship problems, depression, anxiety

Kevin Leehey, M.D.

296-3835

basic medical principles
Basic Medical Principles
  • H&P, labs, hearing, vision
  • Educational assessment
  • Experienced and well trained clinician
  • 365 days, 24/7
  • Individualize and fine tune treatment

Kevin Leehey, M.D.

296-3835

treatment
Treatment
  • Individual Therapy
    • Self esteem and impulse control
  • Family Therapy
    • It is more difficult to parent a youngster with ADHD

Kevin Leehey, M.D.

296-3835

treatment1
Treatment

3. School/Work

  • Special education, 504 Accommodation
  • Positive home-school communication
  • The transition from elementary to middle school and again from middle school to high school
  • Environmental manipulation

4. Medication

Kevin Leehey, M.D.

296-3835

treatment2
Treatment

5. Additional or Alternative treatments

  • Martial arts
  • Exercise/sports
  • Biofeedback (“Neurofeedback”)
  • Sensory integration treatment
  • Nutritious diet, sweets, “junk food”, sugar
  • Vitamins, herbs, and other supplements
  • “Dyslexia” is a language processing phonologic error in language areas of the brain, not a hearing or vision disorder

Kevin Leehey, M.D.

296-3835

medications for adhd 1
Medications for ADHD-1
  • Stimulants
    • Methylphenidate
      • Short and extended duration
    • Amphetamines
      • Short and extended duration
    • Pemoline (Cylert)

Kevin Leehey, M.D.

296-3835

medications for adhd 2
Medications for ADHD-2
  • Non-stimulants
    • Atomoxetine (Stattera)
    • Tricyclics (Imipramine, Desipramine)
    • Buproprion (Wellbutrin)
    • Partial alpha agonists [Guanfacine (Tenex), Clonidine]

Kevin Leehey, M.D.

296-3835

medications for adhd 3
Medications for ADHD-3
  • Combinations/polypharmacy
    • Avoid if possible
    • Stimulant and atomoxetine or other non-stimulant ADHD medication
    • Atomoxetine and SRI
    • Non psych medications
    • Stimulant plus SRI plus DDAVP is safer than desipramine alone

Kevin Leehey, M.D.

296-3835

medications for adhd 4
Medications for ADHD-4
  • Out of the Box
    • amantadine (Symmetrel)
    • modafinil (Provigil)
    • pramipexole (Mirapex)
    • ropinirole (Requip)

Kevin Leehey, M.D.

296-3835

medications for adhd 5
Medications for ADHD-5
  • Beads/sprinkle
    • Adderall XR, Ritalin LA, Metadate CD, Focalin XR
  • Liquid
    • Methylin, Amantadine (Symmetrel)
  • Chewable
    • Methylin
  • Patch

-Catapres, MPH (soon)

  • Osmotic pressure release

- Concerta

  • Compounding

Kevin Leehey, M.D.

296-3835

prescribing for adhd 1
Prescribing for ADHD-1
  • Co-morbidity: Depression, anxiety, tics, substances, bipolar, nicotine
  • Height, weight
  • Appetite decrease and low weight is the most common limiting stimulant side effect
  • Class II, no “refills”, 60 days, less on base post, out of state varies, 90 day mail order
  • Match side effects as well as good effects

Kevin Leehey, M.D.

296-3835

prescribing for adhd 2
Prescribing for ADHD-2
  • Duration
  • Convenience
  • Weight (height less of a concern)
  • Tics
  • “Meaner”
  • Abuse of stimulants
  • Truck driver, pilot

Kevin Leehey, M.D.

296-3835

prescribing for adhd 3
Prescribing for ADHD-3
  • Regular follow-up appointments
  • Not just “med checks”
  • Height, weight, growth curve
  • School, home, peers, activities, etc.
  • Patient and significant other input
  • Benefits and adverse effects

Kevin Leehey, M.D.

296-3835

kevin leehey m d1

Kevin Leehey M.D.

1980 E. Fort Lowell Rd. Suite 150

Tucson, AZ 85719

520-296-4280 fax 520-296-3835

http://leeheymd.com

kevino@leeheymd.com