November Week 1


ADHD: Clinical Practice Guidelines for the Diagnosis, Evaluation and Treatment of Attention-deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics: November 2011. Volume 128;5.
Attention-Deficit-Hyperactivity Disorder. Anna Maria Wilms Flowet, Cathy Scheiner and Linda Grossman. Pediatrics in Review 2010;31;56.
OPTIONAL: Fad Therapies. Sandra F Bragnza and Philip O. Ozuah. Pediatrics in Review 2005;26;371.

An 8-year-old boy is inattentive at home and school, has difficulty completing his homework and is failing reading. Physical examination findings are normal, he has friends at school and the family has been living in their newly built home for the past 3 years. You begin to discuss a diagnosis of attention-deficit/hyperactivity disorder.  His mother asks you what test you will perform to try to determine the cause of the problem.
1. What tests will you perform?
2. What are the diagnostic criteria for ADHD? How have they very recently changed?
3. Discuss the utility and limitations of rating scales.
4. If a diagnosis of ADHD is made, what coexisting conditions must the patient be evaluated for?
You ultimately diagnose attention deficit/hyperactivity disorder in this 8-year-old boy and initiate therapy with a daily morning dose of long acting methylphenidate. His mother asks about using stimulant medication after school on weekend and during the summer.
1. What do you tell this mother?
2. What is the role of behavioral therapies in treating ADHD? 
3. Discuss guidelines for medication management.
4. List the most common adverse effects of stimulant therapy.
5. Discuss routine monitoring pre/post initiation of stimulant medications.
Shortly after starting stimulant therapy, this 8-year-old boy develops a tic.
1. What do you tell this mom regarding the tic?
2. Should you discontinue the medication?
A few months later, this Mom comes to you after seeing a special on TV and asks your opinion on the utility of eliminating sugar and red dye from her sons diet.
1. What do you this Mom regarding these and other complementary or alternative therapies?