School Problems and the Family physician - Part I

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Common Medications for Attention Deficit Hyperactivity Disorders - Table 2
Medication Indications Contra Dosage Side Effects Monitor
Methyl phenidate ADHD Tics, seizures 0.3 mg/kg/ dose;maximum daily dose,60 mg Loss of appetite, insomnia, head aches, tics,rebound effect School and
home
behavior,
blood
pressure
Dextroam phetamine
ADHD Hypertension, Hyper- thyroidism Age 6 and older, 5 mg qd or b.i.d.;increments of 2.5 mg; maximum daily dose, 40 mg/day Loss of appetite, insomnia, headaches, tics, rebound hypertension School and
home behavior blood pressure
Pemoline
ADHD with attentional problems predominant Abnormal liver studies Age 6 and older, start with 37.5mg qd; increments of 18.5mg per week;maximum dailydose, 11 2.5 mg/
day
Loss of appetite, insomnia, headaches, tics, rebound hepatic dys
function
School and
home
behavior, liver functions
Imipramine and Desipramine
ADHD with intolerence or ineffectiveness of stimulants Concomitant use of monoamine oxidase inhibitor 1-2.5 mg/kg/ day; maximum daily dose, 5 mg/kg/day Nervousness, sleep disorders tiredness,GI disturbance; other reactions observed in
adults
School and home behavior, liver func tions,ECG
Clonidine


ADHD with aggressive volatile behavior ECG abnormality 3-4 ug/kg/day; start with 0.05mg hs and increase by 0.05 mg every 3rd day to t.i.d.; maximum daily dose,
8 ug/kg or
0.5 mg/day
Sedation, dry mouth, constipation ECG,School
and home
behavior
J. Behaviour modification: This is developed in cooperation with school, special service personnel or a psychologist. Parent groups and reading materials can also help.
K. Special educational needs. Some schools offer training in social skills and impulse control.
L.Family therapy and/or individual psychotherapy: Indicated in children who have been abused or neglected which contribute to or exaggerate a primary ADD.
M.A change in the living circumstance or teacher can affect the child.

SUMMARY
a. Diagnosis of ADHD includes impulsive behaviour that is present before the age of 7, with symptoms observed for at least 6 months in at least 2 settings.
b. The role of family physician is to identify treatable causes for
hyperactivity (eg. Hyperthyroidism) and to diagnose ADHD as per the guidelines.
c. A complete assessment of educational background and programme is mandatory in children with suspected behavioural problems before making the final assessment and conclusion.
d. A Psychologist reference is indicated in all children with suspected ADHD to avoid overlooking associated emotional problems.
e. The family physician should be thoroughly aware of the drugs used in ADHD, their interactions and adverse effects.

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