Attention Deficit Disorder (Hyperkinetic Treatment)

Historically this was an issue with children but nowadays it’s present with adults as well.  We thought children outgrew it, and they did but the symptoms are different with adults.  When we look at children, the problem is not the physical over-activity and short attention span, that’s nearly all kids anyway, but it’s the impulsive, antisocial behavior that sets them apart.  This is where the teacher would say I cannot control this child and they are always disturbing my class.  One way to deal with it is to put the individual in an environment with a minimal amount of distraction.  But that doesn’t always work.

What you see in adulthood is that the person cannot focus and learn.  The incidence of this shows a greater percentage in males but it still does happen in females.

Treatment

Psychological and educational: such as putting people in the proper environment.  If that doesn’t work we have to look at medications.

Hyperkinetic treatment medications (stimulants): This sounds totally backwards.  The last drug class you would think would treat a child would be a stimulant, but that’s what they are prescribed.  We can’t say exactly how they work but we could give a theory:  Possibly the stimulant is stimulating the part of the brain that causes focus and concentration.

• Contraindications: Epilepsy and hypertension.  Same as anorectic agents, since these are stimulants as well.
• Side effects: anorexic properties, dizziness, dependence.

Hyperkinetic Treatment

• Methylphenidate (Ritalin, Concerta) – p.o. – Ritalin (Schedule II) is a common drug used for this purpose.  There’s also a drug called Concerto that features a controlled release.  You take it in the morning, it releases a dose in the morning, then another dose in the early afternoon so it covers the individual in the day time because you don’t want the drug in their system by the time it’s time to go to bed.  Without the control release, we have the regular methylphenidate but then the dose would have to be taken at school and administered by a nurse somewhere between 12 and 1 o clock in the afternoon.  With Concerto, you don’t have to worry about taking that second dose at school.
• Dexmethylphenidate (Focalin) – p.o.- This drug is just ritalin with a different format where the drug is in the active form state.  Clinically it doesn’t have an advantage to ritalin, but when we’re dealing with mental health, it’s not a science, it’s more of an art of trying to find the right drug for the individual.
• Lisdexamfetamine (Vyvanse) – p.o. – Recent drug.  Notice how it’s spelled -amfetamine.