Lainey Fuller, a 10-year-old girl with attention-deficit/hyperactivity disorder [ADHD], has been taking atomoxetine [Strattera] for the past 4 months. It has not improved her symptoms, so her healthcare provider is changing her prescription to methylphenidate [Ritalin]. Lainey's mother asks, "Isn't Ritalin a stimulant? That doesn't make any sense. How is a stimulant going to help Lainey get better?" What is the nurse's best response?
a "We will have to watch Lainey's growth carefully when she is taking Ritalin because stimulants can decrease the amount of height and weight she gains."
b "Side effects with Strattera are less serious than with stimulants, but there is an increased risk of suicide in children taking Strattera, which is why we are making the switch."
c "Stimulants like Ritalin will cause side effects like headache, increased heart rate, loss of appetite, and insomnia even when they are successful in treating ADHD."
d "It does seem like the opposite of what should happen, but stimulants help improve focus and attention in children with ADHD and do not increase hyperactivity."
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Disorders of Childhood and Adolescence
Terms in this set [18]
Diagnostic criteria
Essential feature of ADHD is a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequent and severe than is typically observed in individuals at a comparable level of development.
Three subtypes of ADHD
ADHD, combined type; ADHD, predominantly inattentive type; ADHD, predominantly hyperactive/impulsive type
ADHD, combined type
you meet 6 symptoms of both sections [inattentive and hyperactivity- impulsivity]
ADHD, predominantly inattentive type
you meet the 6 symptoms of inattentiveness but not the 6 symptoms of hyperactivity-impulsivity
ADHD, predominantly hyperactive/impulsive type
you meet the 6 symptoms of hyperactivity-impulsivity but not the 6 symptoms of inattentiveness
DSM does not contain the term ADD anymore
would be classified as ADHD predominantly inattentive type
DSM does not contain the term hyperactive anymore
would be classified as ADHD predominantly hyperactive/impulsive type
Age Of Onset
some of the hyperactive-impulsive or inattention symptoms that cause impairment must be present before age 7 years
Prevalence
some impairment from the symptoms must be present in two or more settings; 3%-5% of children have ADHD
Sex Ratio
4 to 9 times more common in boys than girls [4:1 to 9:1]
Relationship to Learning Disorders
Of all children who have learning disorders, about 25% also have ADHD; these disorders are comorbid
Associated Features
Children with ADHD have trouble forming relationships or friendships with other children; having symptoms of ADHD is the most common reason children are referred to psychiatric services or some kind of pediatric facility
Course/ Prognosis
remain stable in early adolescence; decreases in late adolescence; decreases/ remits even more in adulthood [however some adults do have ADHD]
Etiology
Very strong genetic component of ADHD; Evidence of some structural abnormality in their brain; Maternal smoking and drinking; If during delivery, child does not receive oxygen
NO empirical evidence that foods or sugars cause ADHD
however if a child does eat a lot of sugar and is then hyper; that is something to take into consideration
Treatment
Medication and Behavior Modification Programs
Medication
Stimulants [still unknown as to why this paradox occurs]; Ritalin and Adderall;
Behavior Modification Programs
Behavior Therapy; Behavior Modification; Reward System that focuses on behavior
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