Management Of Attention Deficit Hyperactivity Disorder Research Articles

8.4 Assessment and Management of ADHD in Youth With ASD

The DSM-5 is the first diagnostic manual to allow clinicians to make concurrent diagnoses of ASD and ADHD. ADHD is now one of the most common comorbidities for youth with ASD. Diagnosis of ADHD is complicated by parents and teachers who do not know whether the observed behaviors are truly related to ADHD symptoms of inattention and hyperactivity/impulsivity or whether they are related to the social demands of a situation. These measurement issues can interfere with accurate diagnosis and treatment of these behaviors and may be a key contributor to the relatively poorer long-term prognosis of youth with diagnoses of ASD and ADHD. The objectives of this session are as follows: 1) to review recent literature on phenomenology, psychological factors and functional outcomes, and pathophysiology of ADHD in ASD; and 2) to review treatment data for symptom management in youth with ASD with and without intellectual disability.

5.9 Opportunities and Challenges in Using a Mobile Health (mHealth) Intervention to Optimize Early Stimulant Treatment in Children With ADHD: Findings From the MH-2™ Pilot

ADHD is a very common (prevalence 4–12% of US children ages 4–17 years), chronic, debilitating, and costly neurodevelopmental illness. Efficacy of stimulants is well established, and the use of treatment guidelines is encouraged, but management of childhood ADHD remains poor, especially in community-based settings. Given near-universal access to smart phones in the United States, mobile health (mHealth) holds promise for improving quality of ADHD treatment in community-based settings. Pilot study was designed to evaluate the feasibility and acceptability of MH2TM, a web-based mobile health application (app) developed to optimize early stimulant treatment for children with ADHD.

4.68 Role of S-Adenosyl Methionine, Zinc, and Magnesium in Management of Pediatric Depression and ADHD

4.68 Role of S-Adenosyl Methionine, Zinc, and Magnesium in Management of Pediatric Depression and ADHD

Systematic review of the screening, diagnosis, and management of ADHD in children with epilepsy. Consensus paper of the Task Force on Comorbidities of the ILAE Pediatric Commission

Attention-deficit/hyperactivity disorder (ADHD) is a common and challenging comorbidity affecting many children with epilepsy. A working group under the International League Against Epilepsy (ILAE) Pediatric Commission identified key questions on the identification and management of ADHD in children with epilepsy. Systematic reviews of the evidence to support approaches to these questions were collated and graded using criteria from the American Academy of Neurology Practice Parameter. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) requirements were followed, with PROSPERO registration (CRD42018094617). No increased risk of ADHD in boys with epilepsy compared to girls with epilepsy was found (Level A). Valproate use in pregnancy is associated with inattentiveness and hyperactivity in offspring (1 class I study), and children with intellectual and developmental disabilities are at increased risk of ADHD (Level A). Impact of early seizure onset on development of ADHD was unclear (Level U), but more evident with poor seizure control (Level B). ADHD screening should be performed from 6 years of age, or at diagnosis, and repeated annually (Level U) and reevaluated after change of antiepileptic drug (AED) (Level U). Diagnosis should involve health practitioners with expert training in ADHD (Level U). Use of the Strength and Difficulties Questionnaire screening tool is supported (Level B). Formal cognitive testing is strongly recommended in children with epilepsy who are struggling at school (Level U). Behavioral problems are more likely with polytherapy than monotherapy (Level C). Valproate can exacerbate attentional issues in children with childhood absence epilepsy (Level A). Methylphenidate is tolerated and effective in children with epilepsy (Level B). Limited evidence supports that atomoxetine is tolerated (Level C). Multidisciplinary involvement in transition and adult ADHD clinics is essential (Level U). In conclusion, although recommendations could be proposed for some of the study questions, this systematic review highlighted the need for more comprehensive and targeted large-population prospective studies.

Are Adult ADHD Patients Good Informants of Their Symptoms? A Qualitative Literature Review of Concordance Between Clinician and Self-Report ADHD Symptoms.

To conduct a comprehensive review on the agreement between clinician-rated and self-reported attention-deficit/hyperactivity disorder (ADHD) symptoms in adults, the following terms were searched in PubMed: "ADHD self-concordance," "Self-report AND ADHD AND Valid," "(self-report) AND ADHD AND clinician," and "(self-report) AND ADHD AND versus AND investigator." Nine articles met our inclusion and exclusion criteria (English language, operationalized measures of clinician-rated and self-reported ADHD, and neither a review nor opinion article). Among the clinical studies, correlation coefficients were on average 0.69 for the total ADHD symptoms score. The epidemiological studies had an average kappa statistic of 0.58 for ADHD diagnoses. The studies of adult relatives of youth with ADHD had an average correlation coefficient of 0.74 for the ADHD total symptoms score. Our review supports the informativeness of self-reported assessments of ADHD symptoms, which has important implications for management and monitoring of ADHD.

Prevalence of and Factors Associated With Long-term Concurrent Use of Stimulants and Opioids Among Adults With Attention-Deficit/Hyperactivity Disorder

There exist limited data on the long-term concurrent use of stimulants and opioids among adults with attention-deficit/hyperactivity disorder (ADHD), a population at risk for prescription drug abuse. To assess the prevalence and secular trends of and the factors associated with long-term concurrent use of stimulants and opioids among adults with ADHD. This cross-sectional study assessed Medicaid Analytic eXtract data from 29 states between 1999 and 2010. Medicaid fee-for-service enrollees aged 20 to 64 years with ADHD who were continuously enrolled for more than 12 months after receiving an ADHD diagnosis were included. One 12-month continuous enrollment period was randomly selected as an observation unit for each enrollee. Multivariable regression models were used to determine secular trends in the prevalence of and the potential risk factors associated with long-term concurrent stimulant-opioid use. Analyses were conducted between January 1 and December 31, 2017. Risk factors measured during the first half of the 12-month observation unit. Prevalence of long-term use of stimulants and opioids overlapping for at least 30 consecutive days was measured during the second half of the randomly selected 12-month observation unit. Of the 66 406 Medicaid-enrolled adults with ADHD who were identified as eligible, 35 670 (53.7%) were 20 to 30 years old, 37 155 (56.0%) were women, and 52 551 (79.1%) were non-Hispanic white individuals. Of these 66 406 adults with ADHD, 21 723 (32.7%) used stimulants, and 3590 (5.4%) were long-term users of stimulants and opioids. Long-term opioid use was more common among adults with ADHD who used stimulants (3590 of 21 723 [16.5%]) than among those with ADHD who did not use stimulants (5826 of 44 683 [13.0%]). Long-term concurrent stimulant-opioid use increased between 1999 and 2010 (adjusted prevalence relative ratio [PRR], 1.12; 95% CI, 1.10-1.14). Compared with patients aged 20 to 30 years, the prevalence of long-term concurrent stimulant-opioid use was higher among patients in their 30s (PRR, 1.07; 95% CI, 1.07-1.08) and was further increased among patients in their 40s (PRR, 1.14; 95% CI, 1.12-1.15) and 50s (PRR, 1.17; 95% CI, 1.16-1.19). Other strongly associated risk factors included being non-Hispanic white (black PRR, 0.93; 95% CI, 0.92-0.93; other PRR, 0.97; 95% CI, 0.97-0.98; vs white), living in the southern United States (Midwest PRR, 0.98; 95% CI, 0.97-0.98; Northeast PRR, 0.94; 95% CI, 0.93-0.94; West PRR, 0.95; 95% CI, 0.94-0.96; vs South), and receiving a diagnosis of substance abuse disorder (PRR, 1.04; 95% CI, 1.03-1.05), depression (PRR, 1.02; 95% CI, 1.01-1.03), anxiety disorder (PRR, 1.05; 95% CI, 1.04-1.07), chronic pain (PRR, 1.10; 95% CI, 1.07-1.13), chronic obstructive pulmonary disease (PRR, 1.05; 95% CI, 1.04-1.07), or cardiovascular disease (PRR, 1.02; 95% CI, 1.01-1.03). Long-term concurrent use of stimulants and opioids among adults with ADHD is common. This study suggests that clinical and research priorities should be made toward understanding the benefits and risks of long-term coadministration of stimulants and opioids in the management of ADHD and co-occurring pain conditions.

What stops practitioners discussing medication breaks in children and adolescents with ADHD? Identifying barriers through theory-driven qualitative research

National and international guidelines on the treatment of attention deficit hyperactivity disorder (ADHD) in children and adolescents call for annual reviews to assess continuing need for medication by considering brief periods without medication, referred to as ‘Drug holidays’. However, drug holidays are reactively initiated by families, or recommended by practitioners if growth has been suppressed by medication rather than proactively to check the need. There is little evidence of planned, practitioner-initiated drug holidays from methylphenidate. The aim of this study was to identify what stops practitioners from routinely discussing planned drug holidays from methylphenidate with children, adolescents, and their parents. Practitioners involved in shared-care prescribing for children and adolescents with ADHD in one UK County were included. Interviews with 8 general practitioners (GPs) and 8 Child and Adolescent Mental Health Service (CAMHS) practitioners were conducted. Transcripts were analysed qualitatively against the components of the Capability–Opportunity–Motivation–Behaviour (COM-B) model. Possible interventions for increasing prescribers’ engagement with planned drug holidays were considered in response. Multiple barriers to practitioner engagement in planned drug holidays from methylphenidate were identified. Capability, in terms of knowledge and skills, was not a barrier identified for CAMHS practitioners but was for GPs. Opportunity was a main barrier for both groups, who reported lack of time and the absence of educational material about drug holidays. Motivation was more complex to define, with CAMHS practitioners questioning the need for drug holidays and GPs being more accepting due to worries about long-term medication side effects as well as cost savings. ‘Education’ and ‘enablement’ interventions were identified as key activities targeting all three components, which could feasibly increase uptake of practitioner-initiated planned drug holidays from methylphenidate. The application of the COM-B system identified a number of key barriers to practitioner engagement with drug holidays in children and adolescents with ADHD. Accordingly, a number of interventions could be developed to facilitate change. For example, educating and training GPs about ADHD management and drug holidays, and developing a decision aid to help families make informed decisions about whether or not to implement drug holidays could be used.

Attention Deficit-Hyperactivity Disorder Group Visits Improve Parental Emotional Health and Perceptions of Child Behavior.

Group visits (GVs) are a promising intervention, but more work is needed to establish intervention effects. The objective was to evaluate the effectiveness of GVs and compare them with individual visits (INDs) for chronic care of attention deficit-hyperactivity disorder (ADHD). Caregivers and children (6-12 yrs) with ADHD participated in a comparative effectiveness trial from April 2014 to June 2015. Families were offered ADHD follow-up every 3 months as GVs versus INDs. Outcomes included ADHD core symptoms, child functioning at home, quality of life, perceived social support, and ADHD-related parenting challenges. Change scores from baseline to the study end were examined for parent and child outcomes within and between treatment conditions. Ninety-one children from 84 families participated. Eighteen families withdrew or were lost to follow-up. GV families attended more visits over 12 months, had significant improvement in mean parental emotional health (p = 0.04), and had a greater decrease in challenges related to misbehavior compared with IND families (p < 0.03). GV families experienced significant improvements in child functioning at home (p = 0.01) and reported more time for themselves, other siblings, and routine household activities (p < 0.01). Children receiving care as INDs reported a significant drop in mean emotional health. There were no significant changes in other outcomes. Families participating in GVs experienced multiple improvements related to family functioning and attended more follow-up visits. Findings confirm the effectiveness of the GV intervention in delivering critical parenting support as part of ADHD management.

Supplementation with polyunsaturated fatty acids (PUFAs) in the management of attention deficit hyperactivity disorder (ADHD).

While pharmacotherapy and psychosocial interventions are recommended as the primary frontline treatment for attention deficit hyperactivity disorder (ADHD), alternative approaches to managing ADHD are becoming increasingly popular among patients and their families. Supplementation with polyunsaturated fatty acids (PUFAs) is an example of this. PUFA supplementation is not recommended by guidelines for managing ADHD; however, patients may still decide to use it. To provide direction to healthcare professionals (HCPs) managing ADHD, eight international experts in the field of adult and child ADHD came together for the Continuum Education Board: Omega Supplements in ADHD meeting. This commentary summarises the panel's consensus that current evidence suggests PUFA supplementation has a small beneficial effect on behaviour in children with ADHD, and that further high-quality research is needed to clearly evaluate and define its role in the management of ADHD of children, adolescents and adults. The panel concluded that in cases where patients use PUFA supplementation, HCPs should be comfortable explaining the potential gains that they may have and their possible side effects. The panel also concluded HCPs should not reinforce the idea that PUFA supplementation should replace treatment approaches with a more robust evidence base for managing ADHD.

Variability and trends in the consumption of drugs for treating attention-deficit/hyperactivity disorder in Castile-La Mancha, Spain (1992–2015)

IntroductionAttention-deficit/hyperactivity disorder (ADHD) is one of the most common behavioural disorders of childhood; its prevalence in Spain is estimated at 5%-9%. Available treatments for this condition include methylphenidate, atomoxetine, and lisdexamfetamine, whose consumption increases each year. Material and methodsThe prevalence of ADHD was estimated by calculating the defined daily dose per 1000 population per day of each drug and the total doses (therapeutic group N06BA) between 1992 and 2015 in each of the provinces of Castile-La Mancha (Spain). Trends, joinpoints, and annual percentages of change were analysed using joinpoint regression models. ResultsThe minimum prevalence of ADHD in the population of Castile-La Mancha aged 5-19 was estimated at 13.22 cases per 1000 population per day; prevalence varied across provinces (P<.05). Overall consumption has increased from 1992 to 2015, with an annual percentage of change of 10.3% and several joinpoints (2000, 2009, and 2012). Methylphenidate represents 89.6% of total drug consumption, followed by lisdexamfetamine at 8%. ConclusionsAnalysing drug consumption enables us to estimate the distribution of ADHD patients in Castile-La Mancha. Our data show an increase in the consumption of these drugs as well as differences in drug consumption between provinces, which reflect differences in ADHD management in clinical practice.

PMH71 - Psychotherapy and Mental Health Counseling for Children with Attention-Deficit Hyperactivity Disorder (ADHD)

ADHD affects about 11% of children aged 4-17 years in the US. The symptoms of ADHD impact not only on the child, but also on parents, families and society. Although pharmacotherapy is key to ADHD management, research has shown behavioral therapies can be helpful in relieving ADHD symptoms. The study aimed to investigate the prevalence and pattern of psychotherapy/mental Health counseling for children with ADHD in US. ambulatory care settings. A retrospective population-based study was conducted by analyzing a national database from the US. National Ambulatory Medical Care Survey. Patients 17 years of age or younger with a diagnosis of ADHD were included. A series of weighted descriptive analyses were used to estimate the prevalence of psychotherapy/mental Health counseling. A weighted logistic regression was performed to examine the counseling services across various patient and physician characteristics. All analyses utilized SAS PROC SURVEY applications and incorporated sample weights and standard errors to adjust for the complex sampling design. Among 884.7 million outpatient visits that took place in 2014, 7.7 million visits were encountered from children with ADHD diagnosis. Male accounted for more than twice of ADHD visits than female (67.4% vs. 32.6%). 85.5% of the children received at least one medication for ADHD treatment including CNS and non-CNS stimulants. However, only 3.6% of the children got referral for a mental health counseling; and 7.8% of them received a psychotherapy. The results of the weighted logistic regression showed no significant factor associated with the counselling after controlling for race, region, payment type, and physician specialty. This study found that children with ADHD were not commonly received any referral for psychotherapy and mental Health counseling from their ambulatory care providers. It is important to recognize potential benefits from alternative treatment options and bring coalitions together to improve ultimate patient-centered outcomes.

Are Teachers Ready? Preservice Teacher Knowledge of Classroom Management and ADHD

It is well documented that teachers feel unprepared to handle classroom management challenges in their classrooms. This lack of preparedness in classroom management, specifically for students with mental health concerns, is one of the leading reasons for teacher attrition. Yet, little is known about what teachers know about classroom management strategies and children’s mental health difficulties upon entering the classroom. The present study seeks to understand preservice teachers’ knowledge of classroom management strategies and attention-deficit/hyperactivity disorder (ADHD) in the United States. Participants were preservice teachers (n = 107; 95.3% female; 75.4% Hispanic) about to enter their student teaching internship. Teachers’ accurate knowledge of classroom management strategies, accurate knowledge of ADHD, misperceptions of ADHD, and lack of knowledge of ADHD were investigated and related to teacher characteristics (i.e., hours of professional development) and sense of efficacy. Teacher knowledge of classroom management stategies, attention-deficit/hyperactivity disorder (ADHD), and sense of efficacy were evaluated using self-report measures. Overall, preservice teachers achieved 60.7% accuracy on the measure of classroom management strategies and 49% accuracy on the knowledge of ADHD measure. There were no associations between teachers’ knowledge of ADHD or classroom management strategies and teacher efficacy or characteristics. The results of this study reveal large gaps in preservice teachers’ knowledge of ADHD and classroom management strategies. Implications for teacher training programs are discussed.

Monitoring following pharmacological management of ADHD

Monitoring following pharmacological management of ADHD

The Management of ADHD in Children and Young PeopleEdited by ValHarpinLondon: Mac Keith Press, 2017£34.95 (Paperback), pp 275 ISBN: 978‐1‐909962‐72‐9

The Management of ADHD in Children and Young People provides a comprehensive and detailed approach to this common condition. It is edited by Val Harpin who is a neurodevelopmental paediatrician based in Sheffield, UK. The contributors come from a wide range of health care professions, drawing experience from specialities that include psychiatry, neurodisability, cardiology, and emergency medicine. The book aims to ‘share sound, practical management advice built on a strong evidence base and many years of practical experience’ with professionals to further their knowledge base and management strategies. As a specialist trainee paediatrician in community child health, this book met my needs and achieved its stated goal. Unlike so many other textbooks it is easy to read as it includes tables and illustrations to enhance the text, and provides case reports and examples of children and young people to further engage the mind of the reader. I could relate to the practical thought processes and solutions offered by this book in relation to diagnosis, management, and support in attention-deficit–hyperactivity disorder (ADHD). The use of evidence in the book is clear throughout with studies being quoted and references given. Not only is the evidence provided but also interpreted and put into a clinical context. There is an extensive reference list at the end of each chapter and useful resources detailed so they can be accessed by the reader to use in practice or to signpost children and young people and their carers. Areas of controversy within the management of ADHD are also discussed. The book is separated into bite-size chapters with each chapter written by a lead author who is a specialist in the area under discussion. The fact the patient is at the centre of care is highlighted by the prologue which is written by a patient with ADHD. The ensuing chapters then deal with referral and diagnosis before moving on to cover different aspects of management, ending with wider issues such as education, adversities faced, and transition. This logical progression makes it easy to digest but also takes the reader comprehensively through all the aspects affecting management of ADHD. Several chapters are related to medication including side effects and drug profile, with comparisons between the drugs and factors to consider when starting, altering, and stopping medication. As a trainee, I found these chapters invaluable as they not only provided the evidence summary but also the writer's experiences in using the medications (including strengths and problems encountered). The last few chapters are dedicated to the wider issues in managing ADHD such as education, substance misuse, and transition of care to adult services. These chapters not only highlight some of the obstacles in helping children and young people with ADHD to manage their condition and how to advocate on behalf of the children and young people, but also provide many helpful techniques and relevant guidelines. The book does not discuss the neurobiology of ADHD. The prognosis of children and young people with ADHD into adulthood is touched upon but not discussed in detail either. It may well be that this reflects the current state of knowledge in this challenging area. Nevertheless, this book goes further than just medical management in ADHD. Rather it provides a holistic approach with the child or young person at its core and the family and multi-professional team supporting them. Although the text describes UK practice, the principles detailed are widely applicable and I have no hesitation in recommending it not only for professionals who work in the field but also for parents and young people who are affected by the challenges of ADHD.

Is Cannabis Use Associated With the Worst Inpatient Outcomes in Attention Deficit Hyperactivity Disorder Adolescents?

ObjectiveTo determine the impact of cannabis use disorder (CUD) on the inpatient outcomes of attention deficit hyperactivity disorder (ADHD) in adolescentsBackgroundPrevious studies have evaluated the impact of CUD on the health-related quality of life in ADHD patients.MethodsWe used the nationwide inpatient sample (NIS) from the Healthcare Cost and Utilization Project (HCUP) from years 2010­–2014. We identified ADHD and cannabis use (CU) as the primary and the other diagnosis, respectively, using validated International Classification of Diseases, 9th Revision, and Clinical Modification (ICD­9–­CM) codes. We used the binomial logistic regression model to generate adjusted odds ratios (aOR).ResultsWe analyzed a total of 11,232 ADHD adolescent hospital admissions from years 2010–2014; of these, 1.79% had CUD. The mean age of adolescents was 14.1 years (SD = 1.79). The prevalence of CUD was highest in ADHD adolescents of 15-18 years (73%) and common in the white race (71%). A higher proportion of ADHD with CUD was transferred to acute care hospitals and skilled/other nursing facilities (5.4% and 7.4% vs. 1.1% and 2.6%, respectively, p-value < 0.001). CUD increases the risk of inpatient charges > $12,247 (median) by 0.6 times (aOR = 1.835; p-value = 0.002) and increases the risk of inpatient stay > 5 days (median) by 0.7 times (aOR = 2.099; p-value < 0.001). The utilization of psychotropic medications was reduced by 0.8 times in ADHD with CUD adolescents by 0.8 times (aOR = 0.448; p-value = 0.017), and the implication of behavioral therapy in the management of ADHD with CUD adolescents was reduced by 0.9 times (aOR = 0.412; p-value = 0.048). Also, there is a 2.8 times higher risk of comorbid alcohol abuse in ADHD with CUD adolescents (aOR = 17.141; p-value < 0.001).ConclusionThe increased risk of substance use is a long-term implication of ADHD in adolescents. It has been determined that comorbid CUD in patients with ADHD not only increases the risk of acute inpatient care but also prolongs the inpatient stay, thus increasing the healthcare cost. Surprisingly, comorbid CUD decreases the utilization of psychotropic medications and behavioral therapy in ADHD. Another major issue is the higher risk of comorbid alcohol abuse in ADHD with CUD adolescents. Further exploration with randomized controlled studies would be required to support and highlight the growing issue of cannabis use among adolescents with ADHD.

Shared Care Models in the Treatment of Pediatric Attention-Deficit/Hyperactivity Disorder (ADHD): Are They Effective?

Objectives:The aim of this review is to evaluate the effectiveness of shared/collaborative care between mental health-care providers and primary care providers (PCPs) on the outcomes of children and adolescents with attention-deficit/hyperactivity disorder (ADHD). This evaluation will be very helpful in the allocation of ADHD resources for models with the strongest evidence.Methods:Using the Preferred Reporting Items for Systematic Review and Meta-analysis statement, we searched for randomized controlled trials, cohort, case–control, and cross-sectional studies on shared/collaborative care models in the treatment of ADHD. Using MEDLINE, PsycINFO, and CENTRAL databases from January 2000 to December 2016, we retrieved English language articles for review. The validation search identified 75 records. Five studies met the inclusion criteria and were analyzed in this systematic review. There were insufficient data for a meta-analysis. The included studies involved 655 children and adolescents who had a diagnosis of ADHD. The Cochrane Collaboration’s tool for assessing risk of bias was used to estimate bias.Results:Overall, the results show that the effects of shared/collaborative care models were small to moderate (effect size: 0.1-0.6, P = .04) on symptom rating scales, but all positively affected functional outcomes (effect size: 0.3-0.7, P = .04-.01). The data indicated that the models were associated with increased PCPs’ comfort levels, but the evidence for increased capacity for diagnosing and managing ADHD was weaker.Conclusions:This review concludes that the current studies do not show strong evidence for the outcome of collaboration between PCPs and mental health professionals on ADHD management. Future research should consider providing education to PCPs on management guidelines prior to conducting the trials, and more innovation is needed to discover methods of collaboration that affect the direct care of ADHD.

The Prevalence of ADHD Patients among Pediatric Dentists in Israel and Knowledge of Dental and Behavioral Aspects of Treating Them.

There are no clear guidelines for managing the dental treatment of children with attention deficit hyperactivity disorder (ADHD). The use of sedation in combination with chronic ADHD medication use is also not well defined. This study surveyed the prevalence of ADHD children, management techniques and knowledge of pharmacologic therapies of these children among Israeli dentists. A specially designed questionnaire was distributed to all Israeli dentists attending a national conference in 2016. Of the 160 dentists who attended the conference, 96 completed the survey (60% response rate), and they included 46 (51%) pediatric dental specialists and 50 (49%) general dental practitioners. The medications Ritalin and Concerta were most familiar to the respondents (98.9%). Eighty-seven (91.1%) of the practitioners responded that their ADHD patients take their usual doses of any drug for treating ADHD symptoms, regardless of whether or not the dentists intended to use sedatives. The practitioners invented their own behavior management techniques with varying degrees of success. There are no specific guidelines for the most effective pharmacologic protocol (co-administration of ADHD drugs and dental sedatives) or behavior management techniques for the provision of optimal dental care to children with ADHD.

Pharmacologic management of attention deficit hyperactivity disorder in children and adolescents: a review for practitioners.

Attention-deficit/hyperactivity disorder (ADHD) is a common neurobehavioral disorder in children and adolescents. ADHD affects multiple aspects of an individual's life and functioning in family, social, and academic realms. Effective management of ADHD is necessary for children and adolescents and may include non-pharmacologic treatments, pharmacologic therapy including use of stimulant and non-stimulant medications, or a combination of the different treatment modalities. In general, medications used to treat ADHD are safe and effective. Medical practitioners can follow a step-wise approach in the selection and adjustment of pharmacologic agents to treat ADHD, while working closely with families, caregivers, and other medical and educational professionals to form appropriate treatment plans. This article reviews practical aspects of pharmacological treatment of ADHD in children and adolescents.

Prevalence of obesity/hypertension in children and adolescents with ADHD and evaluation of total body composition

Objective: Attention-deficithyperactivitydisorder (ADHD) is one of the most commonly diagnosed neurobehavioral disorders in childhood. The aim of the present study was to investigate the obesity/hypertension prevalence of chil-dren with ADHD at the time of initialdiagnosis, to assessthe total body composition, and also to evaluate the asso-ciated risk factors. Methods: The study was carried out with 77 ADHD/100 healthy children and adolescent. All individuals completed a questionnaire form prepared by researchers. The weight, height, and blood pressure (BP) measurements were performed using standardized protocols. Total body composition analysis was performed by ‘bioelectrical impedance analysis’ method. Results: The obesity/hypertension prevalence in ADHD patients were 16.9%, 13.0%, respectively. The obesity prevalence was more frequent and diastolic BP values were higher in pa-tients than controls. Total body fat (%) was higher in both obese and non-obese patients. In females, sistolic BP and diastolic BP values were higher in ADHD group than control group. In girls sleep duration in weekend-days was shorter in patients. Paternal body mass index was higher in ADHD group. Consumption of chocolate/sugar/chicken/ fish and screen time>1 hour in a day were more common in ADHD patients. Conclusion: The high obesity/hyper-tension rates in our study emphasize that the assessment of weight/BP should be a part of the ADHD management. The ADHD patients may also have an increased risk of high total body fat even though individuals are not obese. Short sleep duration, consumption of a high amount of chocolate/sugar/chicken/fish, andscreen time>1 hour per day may be a risk factor for ADHD.

Knowledge of kindergarten and elementary school teachers regarding attention deficit hyperactivity disorder at Qassim region

Background: Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common mental disorders that manifest among children. Despite the fact that the teacher’s role is essential in the assessment and management of pupils with ADHD and the recommendation of participation of teachers for the success and efficiency of diagnoses and treatment, the vast majority of teachers have neither understanding nor knowledge of ADHD. Objectives: The current study explores the kindergarten and elementary school teachers’ knowledge regarding early detection and management of ADHD. Methods: Cross sectional survey using stratified random sampling technique was carried out in governmental and private elementary and Kindergarten schools in four cities of Qassim region, Saudi Arabia. Results: The study included 1095 teachers, 711 (59.3%) did not get information about ADHD during undergraduate studies. Teachers’ overall ADHD knowledge mean was 21.7+5.5 out of 38 marks. Teachers with high qualification degree and kindergarten specialty scored 56.4% and 60.2% respectively. Teachers who attended conferences related to ADHD scored 64.5%, while teachers who read about ADHD or have been ever asked to diagnose/teach an ADHD student had 59.4% and 62.1% respectively. The level of ADHD knowledge perception showed that 76% of teachers were knowledgeable in relation to overall perception about ADHD. Conclusion: Teachers who have higher qualifications or training in identifying ADHD children scored higher in our study.