Preparation for Child Psych PRITE and Boards
(→Further Reading) |
(→Differential diagnosis) |
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*lead exposure/toxicity | *lead exposure/toxicity | ||
*learning and language disorders | *learning and language disorders | ||
| − | *intellectual disability/MR | + | *intellectual disability/MR/Fetal alcohol syndrome |
*developmental disorder | *developmental disorder | ||
*bipolar/mood disorder | *bipolar/mood disorder | ||
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*head trauma | *head trauma | ||
*hyperthyroidism | *hyperthyroidism | ||
| + | *trauma/neglect/reactive attachment disorder | ||
==Special Topics== | ==Special Topics== | ||
Revision as of 20:43, 4 January 2011
Contents
Introduction
Etiology
Diagnostic Criteria
Evaluation
Differential diagnosis
The differential diagnosis must be considered for all children presenting with attention and hyperactivity problems, and it includes the following important conditions:
- lead exposure/toxicity
- learning and language disorders
- intellectual disability/MR/Fetal alcohol syndrome
- developmental disorder
- bipolar/mood disorder
- hearing/vision problems
- sensory processing disorders
- absence and other seizures
- head trauma
- hyperthyroidism
- trauma/neglect/reactive attachment disorder
Special Topics
ADHD and Epilepsy
- Prevalence of epilepsy in children is about 0.05%; these children are more likely to have ADHD than their peers without seizures. This is particularly relevant in children with absence seizures, in whom pharmacologic seizure control may not adequately restore attention.
- Differentiating the symtpoms is important in children with comorbid epilepsy and ADHD, as well as in children with staring episodes (partial complex or absence seizures); the inattention of ADHD will generally respond to touch and redirection, and children do not experience postictal drowsiness. EEG is sometimes necessary for diagnosis.
- Further, children with ADHD are more likely to have subclinical/epileptiform EEG findings as compared to general population. While they are not considered to have seizures/epilepsy, periods of epileptiform changes are often associated with transient impairment of attention and cognition.
- Antiepileptics and ADHD - Children with epilepsy may experience a sudden improvement in learning, attention, social, and behavior domains when their seizures are treated. This was termed the release phenomenon; it is unclear if this effect is due to seizure control or a separate effect of an antiepileptic. However, phenobarbital and topiramate may cause deterioration in attention and behavior.
- ADHD Treatments and Seizures - It is unclear if stimulants lower seizure threshold; the concern is greater with methylphenidate stimulants. However, in children with epilepsy seizures frequency is not increased when methyphenidate is introduced. Bupropion had been found to cause an increase in seizure ferquency in a dose dependent fashion (SR preparation is safer as it results in lower serum levels). (1)
High-Yield Facts
Further Reading
(1) Practice Parameter, ADHD. JACAP, 46:7, JULY 2007 (2) Schubert R. Attention Deficit Disorder and Epilepsy. Pediatric Neurology 2005;32:1-10.