ADHD

Discussion Summary

Discussion Moderator: Cliff O'Callahan, MD

Questions:

1. Are there better ways to schedule a work-up for a child with behavior
suggestive of ADHD?

2.Are there tools that are helpful in the evaluative process?

3. How are providers distinguishing between ADHD and FAS or PTSD etc?

4. Blind trials being used?

5. Favorite stimulants or other medicines.

6. Teens and adults coming for consults on ADHD!

Discussion:

1. Variablility in scheduling. Some use a RN case manager as first pass to
discuss need for visit and send a pack with questionaires. Then it looks
like many folk do two 30-40 minute visits (some do an initial 60 minute
visit). Some have the first visit with parents only.

2. Varienty in tools used with Connors, ACTeRS, ANSER forms all used.
Mention was made of the Vanderbilt NICHQ forms. They are now (4/2004) the
standard forms in the NICHQ and AAP ADHD toolkits and are available free or
bought as a whole packet. Most require school records in addition to
teachers filling out standard forms. For those without access to
psychologists etc, some use additional screening forms like the Achenbach,
Child Behavior Checklist, and Youth Self Report.

3. Some have access to FAS multidisciplinary clinics, others only wish.
Variablity in access to psychologists and pschiatrists exist, compounded by
distance to "accesible" providers. Most believe that a LARGE proportion of
our "ADHD" children and youth are ARND.

4. Only a couple people seem to do blind trials (placebo vs stimulant) or
open trials of various stimulants.

5. Some still use Ritalin but most seem to be using long acting formulations
and getting them on their formularies! (The original discussion was before
the advent of Strattera). Concerta, Adderall often cited.

6. Not many of us pediatricians doing older teen and adult ADHD evals, but
diagnosis of children has led some parents to go in search of evaluations
for themselves.

Addendum from 4/2004: It was a great discussion and will be good to repeat
after folk have had some time to work with all the newer long acting
stimulant formulations and Strattera. The most significant update is the
ADHD toolkit available through the AAP. It is not perfect but is a great
start, easy to teach residents, and provides some uniformity throughout the
country. The big weakness for Native children is the very shallow provider
eval form that does not push us strongly enough to consider co-morbidities
like ARND, FAS, ODD, PTSD, reactive attachment disorder etc.