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Dx ADHD Treatment: Dx Attention Deficiency Hyperactivity Disorder


There is no consensus on the increase occurrence of ADHD disorders: genetic and environmental exposure have less contributing evidence then prenatal smoke exposure, low socioeconomic status and parental marital instability.
Treatment is changing. "Pharmacological management of attention-deficit hyperactivity disorder (ADHD) has expanded beyond stimulant medications to include alpha 2 adrenergic agonists." These (guanfacine ER, clonidine ER) can be used alone or in combination with CNS stimulants; in children 6-12; and in the 20-35% of subjects that have an inadequate response to initial stimulant therapy.

A large review supported the use of non-antipsychotic medications (atomoxetine, clonidine IR, guanfacine IR, exmethyphenidate, mixed amphetamine salts, methyphenidate...). Atomexetine is available in Canada at a large cost savings, and is not considered an amphetamine.

In adolescent and adults, screening for low hormonal levels of thyroid, adrenal hormones (DHEA) and pregnenolone may identify other treatable factors.

Attention-deficit/hyperactivity Disorder (ADHD)

is classified as a developmental disorder and/or disruptive behavior disorder identified three times more often in boys with
1. predominantly inattentive,
2. predominantly hyperactive-impulsive or
3. combined.

Medications Used in the Treatment:
1.Central Nervous System Stimulants: such as Ritalin®, Adderall®, Concerta®, Provigil®
2. Central Alpha Angonists: Intuniv®.
3. A2 adrenoceptor agonists: Clonidine®.
4. SSRIs: Selective Serotonin Reuptake Inhibitors: Celexa®, Prozac®, Cymbalta®, and more
5. Atypical Antipsychotics: Abilify®/ aripiprazole, etc.

Suggested Information Links:
 *Merck Manual Home Edition
 *NHS Choices

*[Editor]: Children with higher levels of TSH and lower levels of T4 were at higher risk for attention deficit and hyperactivity/impulsivity symptoms.

*[Editor]: Low DHEA and low Pregnenolone levels were directly correlated with DSM-IV diagnosed teen ADHD males implying "our findings suggest a possible protective effect of various neurosteroids on the expression of ADHD symptomatology."
*Pregnenolone supplementation titrated to 100mg/day showed "a statistically significant reduction in the Hamilton Rating Scale for Depression and Young Mania Rating Scale...Pregnenolone appears to be safe and well tolerated."
*Amino Acid Precursors "67% of 85 patients achieved significant improvement with only (an intravenous protocol consisting of) amino acid precursors of serotonin and dopamine."

Potential Organizational Links:
 *ADDA: Association for Adults
*CHADD: Child and Adult Association

See A.D.D. for more information.

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